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HomeMy WebLinkAboutSWG2022-00158 - SWG As-Built - 9/8/2023 i J1 C V Mason County OSS Installation Report pg. 1 U MASON COUNTY PUBLIC HEALTH APPLICANT/ PER ORMATION Permit Number SWG 2022-00158 Parcel # 42216-53-00036 Applicant Name Tara &Jay Jarrells Subdivision (Name/Div/Block/Lot) Applicant Address P.O.Box 1933 Lake Cushman Div. 16 Lot 36 City, State, Zip Shelton, WA 98584 Installer Name Payton Goos Site Address 51 N. Bass Place Designer Name Dale L. Tahja INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other System Type Pressure Trenches Pretreatment Type BNR-500 NuWater >5 ft. from foundation? - - ❑ N/A ®YES ❑ NO >50 ft. from wells? - O ---- ❑ NI ❑ Z >50ft.from surface water? - -- - - ❑ El ❑ • Cleanout between building and tank? - - -- S --- ❑ 0 ❑ U Tank baffles present? - �-- ' . -- ❑ © ❑ d 24" access risers over each compartment?- -- --- - - ❑ NI N Effluent filter installed?- �- ❑ El Septic tank capacity (working) 500 g- Manu ctus- _ Hagerman O D-box water level and speed levelers used? ----- -- MIN/A IDYES ElNO DO Manifold/D-box accessible from surface?- - ❑ I ❑ mZ Check valves installed? - - ❑ ® ❑ 6Q 2 Transport Line Size 2 inch Schedule/Class Sch.40 Bedrooms installed (check one) IN 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? - - ❑ I ❑ u. >10 ft.from potable water lines?- - ❑ MI ❑ > 5 ft. from property lines and easements?- - ❑ II d > 30 ft. from downgradient curtain/foundation drains?- - ❑ 0 ❑ Drainfield level and observation ports present - - ❑ N ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Q24" access riser(s) and accessible from surface?- - ❑ ® ❑ F- a Alarm or Control Panel Installed? - - ❑ ® ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ It ❑ D d Pump installed in ❑ Bucket or I On Block or ❑ Other a' Pump Make/Model Liberty 280 © Floats or El Transducer per., Tank draw down 1.5 in/min Pump capacity 33 gpm Squirt Height 10 ft Pump on time 2.25 Pump off time 5 hrs 57.75 min Daily flow set at 180 gpd Updated 8/21/2018 l'A Mason County OSS Installation Report pg. 2 Parcel# ` `.. C) CVia ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES id NO If yes, please describe: Were all components pumped out and properly abandoned per WAC248-272A-0300? - - 0 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: Drakrfeld&manifold orientation&layout,Sepactpump tank iocation,North arrow,reserve drainfieid,existing and proposed buildings,location of wets,waterlines, wets,observation ports,deanouts,and other maintenance access points. incomplete Record Drawings may create additional delays In final Installation approval and related permits. r PPROVE Sir' U 8 '1U13 ii4ASON COUNTY ENVIRONMENTAL HEALTH JBW a Record Drawing Attached ' CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that I installed the system in accordance with l 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 form n attached Record Drawing ' accurete_ form and attached Record Drawing is accurate. oie () S r Signature of Installer __pate r�J r.: 7i' •o t+ th586OoS 1 J 12 ri 006..�'?s� . • e! . • ti N MASON COUNTY PUBLIC HEALTH % I J).�+. The undersigned approves this Installation Report and ,,,f,�_ St t i R-.,.rd Drawing on behalf of Mason County Public .r O. DALE L. TAH JA�� �' +t� LfCNS D D SIGNER t nn r/ III �.. '�. �s._��.►w-.'-..���1. t'i A% Y A� I• _2 2 fxr,, , `Ni Sig atu 7417vironmental Health Specialist Date f l (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated1161nol8 \,.. -.., ..,,, \\. -,..., .. . -174".• //1"---'------- -":4 c-- / fa / -.- / .5 ,/ '''—' / / ' • / AI / /1; ,.. / S- ' -' ' ' 4_44? / / / 6, , *...c._ / , / . , ,,.. / .----// / , /....x -.. / /• , ,o // • '4 / / ' Ject\--.7 a . . 0 t 3/1, N, , / ..„. y/3 • '41 / ' _ /I / ii CAt. 411 .1 / / , NN'Ygra 0 • -42..0 6)4 441"4 , It' -6C) .... . '''-- ---7'3.> -=>> e*". ...i.-4Zs 4. ....-.."'--1-f-'-----. -- ,.....n •- .., ,.. 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