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HomeMy WebLinkAboutSWG2021-00346 - SWG As-Built - 7/25/2023 Mason County OSS Installation Report pg. 1 Q,(‘ MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00346 Parcel # 22017-51-00109 Applicant Name CMH Homes Subdivision (Name/Div/Block/Lot) Applicant Address 5000 Clayton Rd Timberlake Div 9/ Lot 109 City, State, Zip Maryville, TN 37804 Installer Name County Line Development Site Address 241 E Park Loop Shelton, WA Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - 1 2 nn ---- ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - 1 LE-(-�.t-+�-4,7- R is CIZ >50 ft. from surface water? - !;II 0 CI CI HCleanout between building and tank? - - - ! f l! �'-i-....4.- ❑ ❑I CI U Tank baffles present? - 1. l ❑ 1 ❑ i— 24" access risers over each compartment. By_ I�.:� �. ❑ ❑■ ❑ WEffluent filter installed' - ___~ - ❑ 0 ❑ Septic tank capacity (working) 1,250 gal Manufacturer Snyder 9 D-box water level and speed levelers used? - - ❑■ N/A El YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ ■❑ ❑ CO-2 Check valves installed? - - ❑ ❑■ El ❑Q 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑� YES ❑ NO CI >100 ft. from wells?- - ❑� ❑ ❑ W >100 ft. from surface water? - - ❑■ CICI L.T. >10 ft. from potable water lines?- - ❑ ■❑ ❑ z > 5 ft. from property lines and easements?- - ❑ El ❑ fZ > 30 ft. from downgradient curtain/foundation drains? - - ® ❑ ❑ Drainfield level and observation ports present - - ❑ © ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑■ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A El YES ❑ NO • Pump tank capacity(flood) 1,000 gal Manufacturer Snyder < 24" access riser(s) and accessible from surface?- - ❑ MI ❑ H Q. Alarm or Control Panel Installed? - - ❑ El El 2 Control Panel equipped with Timer/ETM/Counter- - Cl © Cl 0 a Pump installed in ❑ Bucket or U] On Block or ❑ Other n'• Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer a. a Tank draw down 1.5 in/min Pump capacity 38 gpm Squirt Height 7 ft Pump on time 2.33 min Pump off time 6 hr Daily flow set at 360 qpd Updated 8121201 3 22° �l- �t` t D� Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES ii No if yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 0 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: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines. wells,observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may oreatv additional delays in final installation approval and related permits. e.- --- p, _c)v-z-k. PPROV J 2 5 2023 MASON COUNTYUL E NVIRONMENTAL HEALTH ® Record Drawing Attached JRw • . 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 fu er ertify that all information contained on this i further certify that all information contained on this fo attached Record Drawing is accurate. form and attached Record Drawing is accurate. fri-5` Signature of Installer Date G) MICHAEL LOVELY ,r a Printed Name of Signee C" •coy �4a ��4 , :5,V,N MASON COUNTY PUBLIC HEALTH N7 The undersigned approves this Installation Report and =?� •' ate s • Record Drawingon behalf of Mason CountyPublic �. PAULA JOY JOHNSON '?' � CtNSritgiONE'le +. Hear.---) EXPIRES - IA)I:1/1(11- 1L .1--2 - ---2-3 -1-.'k 9".23 Sign to nvironmental Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC ViEW ON THE MASON COUNTY WEB SITE Updated 8r2112018 2 P\Q\<- LOU 9 — 87.-t-' ' Scp\t_ \ -aO' v*TER O l0 20" 3C" `tc. DR.\v v\1 k` , / AS 3 uS.\-`T . \ / , .2AQc,Ek_-- 2zo t-1-s;-O0 C o q \_ , .. - -.__ . zH 1 E. OAR 1< LOOP HL o - 7- Audio-Visual Alarm v, ®O �tir. t^ O �� ��ST 'p��_. U' 3 Cleanout c-1 p O - 5 co O3 1250 Gallon Septic Tank 0 F.- 2-Compartment with Effluent Filter 0 1,000 Gallon Pump Chamber O Valve Control Box 4 • . \ '' 0- t'io sLoo� i yk'1 -2 a. 0.; t L� TA2E N 0K . 1 - .ES E CZV \U `.€,Tvtt \ili' 81- t 4PP ROVE ., .--.4)) JUL 2 5 2023 ' O. 1Lh h ON COUNTY ENVIRONMENTAL HEAL i r = o s<9 0� PAULA JOY JOHNSON 1. \ NI JBW ul tvlo groN 1 -(`i --- 23