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HomeMy WebLinkAboutSWG2021-00557 - SWG As-Built - 9/13/2023 DocuSign Envelope ID:824AB93D-9COD-471B-BF2C-5A34CE5C247F Ra Mason County OSS Installation Report pg 1 SEP 1 12023 M . SON COUNTY PUBLIC HEALTH APPLICANT/ PERRRIMMIMA ON Permit Number SWG 2021-00557 Parcel # 3202 -58-03024 Applicant Name FRASER. JULIE &THOMAS Subdivision (Name/Div/Block/Lot) Applicant Address P 0 BOX 604 SHORECREST BEACH ESTATES#1 BLK: 3 LOT: 24 City, State, Zip ALLYN WA 98524 Installer Name Arrow Excavating Site Address 50 E LYNWOOD DR Designer Name Micah Halverson INSTALLATION CHECKLIST © Full System Installation El Tank(s)Only El Drainfield Only El Repair El Other System Type ATU to Pressure Trenchs Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A X❑YES ❑ NO >50 ft. from wells? - •- El ® ❑ • >50 ft. from surface water? - L . ---------_ ❑ ❑ ❑ FQ- Cleanout between building and tank? - I -- -..-II-WI Eli':-1-- ID 0 CIU Tank baffles present? - ! - - ❑ CI a24" access risers over each compartme l''- `J 6 ct)L3 - CI El CI W Effluent filter installed?- •- x❑ ❑ El B1, `< Septic tank size SOO+ Niiwater gal ._ Manufacturer Hagerman D-box water level and speed levelers used? - - El N/A ❑ YES ❑ NO J oO Manifold/D-box accessible from surface?- - El E ❑ mZ Check valves installed? - - ❑ CI ❑ oQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) El 2 x❑3 ❑4 El 5 ❑6 El Commercial/Other I >10 ft. from foundation?- - ❑ N/A ® YES El NO >100 ft. from wells? ❑ ID ❑ GI W >100 ft. from surface water? - - El El El it >10 ft.from potable water lines?- - ❑ ❑ ❑ Q Z > 5 ft.from property lines and easements?- - CI ® CI w > 30 ft.from downgradient curtain/foundation drains? - - ❑ ® El • Drainfield level and observation ports present - - ❑ ® ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ x❑ El Pump tank setbacks consistant with septic tank? - - ❑ N/A x❑ YES ❑ NO • Pump tank size 1261 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ ® ❑ H a Alarm or Control Panel Installed? - - CI El E Control Panel equipped with Timer/ ETM / Counter- - Cl ® El A PPR ery 4'ii cket or ® On Block or ❑ Other 4 Pump Make/Mode 'be y LP 280 ❑ Floats or 0 Transducer D Tat4k drd4 dna 1.9 in/min Pump capacity 40 gpm Squirt Height 87" ft a MA;ON COLROviw �Imt•i Pump off time 360 min Daily flow set at 360 gpd DJw CALIH Updated 8/21/2018 DocuSign Envelope ID:824AB93D-9COD-471 B-BF2C-5A34CE5C247F Mason County OSS Installation Report pg. 2 Parcel# 32021-58-03024 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES x❑ 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: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines. wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. ® 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 information contained on this foubtiu ,gtpched Record Drawing is accurate. form and attached Record Drawing is accurate. 366A, alitat t 8/23/23 Signature of Installer Date t i 2� '1 Johnny Gilliland 5 1, Printed Name of Signee 4 PP ' V4 MASON COUNTY PUBLIC HEALTH �� 4 yA The undersigned approves this Installation RepeRnd ' ,• Record Drawing on behalf of Masorp my Pu r 1 3 �2 v'� 5100441 Health: t4.UA!trr,, -du�au+T► NSia.HA WON LICEUSED DESIGN B • /9/8/710 EXPIRES:Oaft+sl.l.S_ Signa 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 82112018 0 0 C) c 0) Ti (b () O'+ 30--I • N (n N m (� ,(D C 3 0 i•3 t 60' z- co N (D 3 3 co 3.6ri E Q E. 3 CD al (Dz c'Q3Q 0 S6, Q� 3"N' O (i. 0 w (I, E1 0 O Lt 6� a (30 0 N a. J (D ,-0 a. 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