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HomeMy WebLinkAboutSWG2022-00355 - SWG As-Built - 7/14/2023 Mason County OSS Installation Report pg. 1 ri MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00355 Parcel# 22028-75-00020 Applicant Name Gary & Diana Conner Subdivision (Name/Div/Block/Lot) Applicant Address 7031 SE Arcadia Rd City, State, Zip Shelton, WA 98584 Installer Name House Brothers Construction Site Address Same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST © Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type Attention Zone >5 ft. from foundation? - - ❑ N/A ■❑ YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ z >50 ft. from surface water? - - 1=3 ❑ Q Cleanout between building and tank? - - ❑ . ❑ I— U Tank baffles present? - - ❑ H 24" access risers over each compartment?- - ❑ 0 ❑ a W Effluent filter installed?- - ❑ El ❑ cn Septic tank capacity (working) 1.250 gal Manufacturer House Brothers Tanks k ❑ D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO J �O Manifold/D-box accessible from surface?- - ❑ ® ❑ mZ Check valves installed? - - - - - L k . - ❑ 1■❑ ❑ oa • Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 111 YES ❑ NO 0 >100 ft. from wells?- - ❑ El ❑ w >100 ft. from surface water? - - ❑■ ❑ ❑ LL >10 ft. from potable water lines?- - ❑ ❑■ ❑ � > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ Q Ce > 30 ft. from downgradient curtain/foundation drains?- - ® ❑ ❑ CI Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or g Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A Q YES ❑ NO • Pump tank capacity (flood) 1,200 gal Manufacturer House Brothers Tanks Z < 24" access riser(s) and accessible from surface?- - n ® El ~ a Alarm or Control Panel Installed? - - ❑ El ❑ 2 Control Panel equipped with Timer/ETM /Counter- - ❑ © ❑ m n- Pump installed in ❑ Bucket or 0 On Block or ❑ Other a• Pump Make/Model Zoeller N153 IN Floats or ❑ Transducer eL Tank draw down 3 in/min PuA r'D Squirt Height 5 ft Pump on time 1.5 Minutes Pump off time ours Daily flow set at 360 gpd updated 8212018 JUL 1 4 2023 ilk 1 4 2023 MASON COUNTY ENVIRONMENTAL HEALTH DJA Mason County OSS Installation Report pg. 2 Parcel Z.t.O Zg 7 J 002,o ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES III NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - [] YES NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Dra,nfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainbeld,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create adoitonal delays in final installation approval and related permits. III Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with I certify that the system has been installed in accor- the septic design stamped'APPROVED"by Mason dance with the septic design stamped'APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been cleared/approved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further certify that all information contained on this I further certify that all Informal-on container;(In tt,is form a attac d Record Drawing is accurate. form and attached Record Drawing is accurate. Signet re of Installer Date ;5 '�� Printed Name of Signee APPROVED I ��'Q� array MASON COUNTY PUBLIC HEALTH f i .r r:r .� �'•.aP J The undersigned approves this Installation Report and L 4 2023 �;• sr f ?� Record Drawing on behalf of Mason County Public -1 `*'9 Healt MASON CO, `tTY ENVIRONMENTAL HEA itIN JOY�JdHNSON ?(I LOO Z� DJ A ®`i t 1_ 1 4 10'. 3 _ na ure of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated e2tr2ote As bu:LL- . Div) 0. -rC7 ( CONvu,( • Fcm e i#22oi375-00020 70 S5 }r'car( a Rd *** Sal 1{:1"= Co' lig is. • 420 0 30, 6al 40 Key: 0 Audio-Visual Alarm 0 Cleanout O3 1250 Gallon Septic Tank APPROVED 2-Compartment with Effluent Filter JUL 1 42023 0 1200 Gallon Pump Chamber MASON COUNTY ENVIRONMENTAL HEALTH OValve Control Box DJA (5) 3 X 90i primal - \:,,j, v5i". )1, \\c c)6 @ Sr O.C. M \ \-/, r•,r,.; S \ \ \\ fed Yv� and \ \\\\\\ 50 r a-ife cl v a-ho y\ za vw W1 t,0 W. \ 96'o 4 4 Id Ati - 100' *VI Oft ,o•'"•a''Ply,� I . '� � _ r v�E L L. E kv ✓� 5 00349 .1.�r�' Sf /'� Q yA PAULA JOY JOHNSON ''a '\d y�I 07' 1 JUL .1 4 2t1 i