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HomeMy WebLinkAboutSWG2021-00202 - SWG As-Built - 8/11/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00202 Parcel # 32104-54-00038 Applicant Name Gerald Cassel, Jr Subdivision (Name/Div/Block/Lot) Applicant Address 652 E Pickering Dr ALDERBROOK G &Y#4 TR: 38 , S 48/108 City, State, Zip Shelton, WA 98584 Installer Name Dodge Ecavation Site Address 20 E Paintbrush Ln, Union Designer Name Arrow Septic Designs INSTALLATION CHECKLIST UI Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A UI YES ❑ NO >50 ft. from wells? - - "ITO V- - ' — ElElZ >50 ft. from surface water? ;� ❑ El Q Cleanout between building and tank? - - - ❑� ❑ U Tank baffles present? - -t►I snAt„ Y� / 1-20c23- - - �`l Li El a24' access risers over each compartment?- - - - - l�viRgPo� q�y .■ ❑■ ❑ W Effluent filter installed?- JQ ,-fir E&Tii El ❑ Septic tank capacity (working) NuWater gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - ❑■ N/A ❑ YES ❑ NO 08 Manifold/D-box accessible from surface?- - ❑ ❑■ El mZ Check valves installed? - - - -¢& f"-^,-* -1\--42Y`K- - El 0 ❑ O< 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) A 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercia/Other >10 ft. from foundation?- - ❑ N/A LI YES ❑ NO • >100 ft. from wells?- ((�� ((� ..._—�-- ® ❑ El W >100 ft. from surface water? - ;lr +��u3 `� ® ❑ ❑ LL >10 ft. from potable water lines?- 4 El El El • > 5 ft. from property lines and easements? ��� 2�23- -L ❑ 111 El ce > 30 ft. from downgradient curtain/foundati n drains? - 0 ❑ ❑ in Drainfield level and observation ports pres rttly ❑ © El ❑ Graveless chambers or UI Clean gravel used? (check one) Proper cover installed over drainfield?- - El ii ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A Q YES ❑ NO Y Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator z 24" access riser(s) and accessible from surface?- - ❑ © El H a Alarm or Control Panel Installed? - - El 0 Ill 2 Control Panel equipped with Timer/ ETM/Counter- - El II ❑ n d Pump installed in ❑ Bucket or 0 On Block or ❑ Other d• Pump Make/Model Zoeller N151 ❑■ Floats or ❑ Transducer a. a Tank draw down 1 in/min Pump capacity 25 gpm Squirt Height 2.5 ft Pump on time 2.4 min Pump off time 6 hours Daily flow set at 240 gpd .;rcatec S•21:2:11,, Mason County OSS Installation Report pg. 2 Parcel # 3 21 b 4-- 5 4"' 00038 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 11 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,clearouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 4 PPROYE AUG 1 1 2023 I lulASQN CGtiNTY ENVIRONMENTAL HEALTict JB W Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER /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 and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 05/ro/`z3 L_Sigoaaiure of Installer bate y l `t---e5sa .3. Q Printed Name of Signee £� •.". MASON COUNTY PUBLIC HEALTH i2 :qh The undersigned approves this Installation Report and +,•71 W R-c. d Drawing on behalf of Mason County Public ./? stoc349 ;��' e:ULA JOY JOHNSON ���` Healt fSEt ba iCNgrl'' Sig -tun nvironmental Health Specialist Date (stamp, signature and date) Updated 8/21i2018 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ,r eS e \J e D. -, S eJ ex" .A,S-taA1 e d, (o " defer i 5 repo ✓-eol lcecow,s e y es ev-e cxVe ek wcts 5 cyakeed 1 i2.28 7:____erk I Z1 „, O a 0 C15 L }-D k-` 1 ` 000 74-Z: 0 -33 " Q p S G s L 4 roof 5 25. J Q J C o yl -✓y1�i `- IQ 2 9, �io ys G• ' 4- I*3: ‘S_ Z , a ,Pro Pto � i��+i oe LS -1-vo±S Cn �OSr zs� Pos-rd2G. 2$g ,c, v,4 ; 5 e_ a.s Ga�ic w +L . S.`dc-si- beaci por "/ 4 NOUSeiii ovt pie. , , 7 1 ,,_,' u e Lo / --( 7T-v. Jc e- = Zo ' wa a1 t� la .7•V -So 40 a Pa; v\-k-- Zrus‘t\ L v\ C3._Z—Cu--� Sev: 0 Audio-Visual Alarm 116. �r� _ '32lD4'- /t- 6000Cleanout ` - ? te __ - A ' z. MqI �`� q O3 500 Gallon Pre-Trash tank °`- o a(' � s I f r. O4 NuWa"ter BNR-500 ATti Tank ��`�11 r ` V E / t . _A � 510C349 ) 3 1,000 Gallon PumpChamber N°� ail A JOY JOHNSON . � L'iCE�tS�tSpESiGtv"ft" '�} AUG 1 1 2023 saes ` 0 Valve Control Box —7—Z MASON COUNTY ENVIRONMENTAL HEALTH JBW