HomeMy WebLinkAboutSWG2023-00182 - SWG As-Built - 8/11/2023 -0 ILI [P.) .1. 0 VE if
• +i 11 JUL 26 2023 'HI
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Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2023-00182 Parcel # 221323300030
Applicant Name Estate of Bernard Dorcv Subdivision (Name/Div/Block/Lot)
Applicant Address 9 Chrismas Tree Lane
City, State, Zip Shelton,WA, 98584 Installer Name Jacob Pettit
Site Address 1734 E Spencer Lake Rd Designer Name Cindy Waite
INSTALLATION CHECKLIST
Ui Full System Installation ❑Tanktsi Only 0 Drntnrcld Only ❑Reumr 0 Other
System Type ' ssure Pretreatment Type __ ___
>5 h.from foundation? •
>50 ft,from wells? - Intillralf
E._ , N/A MIYES 0 NO
Z >50 ft. from surface water? - - -
_ - 2023- - ,
Cleanout between building and t� _'
v Tank baffles present? • COCnVTP ENUfR01VMENTAI N�AL ■oic
El
is v I ❑
1=
d 24"access risers over each compartment?. - - _JR W
El111
Effluent filter installed?- 0
Septic tank capacity(working) 1200 gal Manufacturer Hagerman Pre Cast_
C1 D-box water level and speed levelers used? • —
o 0 ManifoldiD-box accessible from surface?• -
® NIA ❑YES ❑ NO
m— Check valves installed? - 0 !I 0
Q MI ❑
0
2 Transport Line Size 2" _ Schedule/Class 40
Bedrooms installed(chock one) 02 0 3 ❑4 ❑ 5 0 ti ❑Commercial/Otr.;f ______
>10 ft.from foundation?- ❑ N/A
YES 0 NO
0 >100 ft.from wells?• -. - _ _ ❑ II 0
-1 >100 ft.from surface water? -
>10 ft.from potable water lines?- ❑ ® 0
Z
Q >5 ft.from property lines and easements?. ❑ ® 0
lY >30 ft.from downgradient curtain/foundation drains?• IN
❑
0 Drainfield level and observation ports present • ❑
0 Graveless chambers or it Clean gravel usee.i (check one) ❑ LE ❑
Proper cover installed over drainfield?• ❑ U 0
Pump tank setbacks consistent with septic tank?-
0 NIA ON YES 0 NO
Y Pump tank capacity(flood) 1200 gal Manufacturer Hagerman Pre Cast
II
H 24 access riser(s)and accessible from surface?• �—
a. Alarm or Control Panel Installed? - - 0 0
Control Panel equipped with Timer f ETM/Counter- ❑
IA
O. Pump installed in 0 Bucket or ® On Block or 0 Other 0
❑
d Pump MakeiModel Liberty LP 280
Floats or 0 Transducer *I
a Tank draw down 1.75
in/min Pump capacity_40.25 gpni Squirt Height __4.3_ _ft
Pump on lime_ 45sec Pump off time 3 hr `v
-- - Daily flow set at -.740__9Cd
I
Mason County OSS Installation Report pg. 2 Parcel u 221323300030
ABANDONMENT RECORD
Were exls•r;cg septic curnportents abanduned as pail of nits project? - - Q YES ❑ N
If yes,please describe We decommissioned the existing sea!! l ,nk
Were all cormorants pumped out and properly abaft!•nrd pet W;, 4l-272A•0300? - 0 YES J r,n
•
' RECORD DRAWING
Thle is a pen-salient record and must be accurate find dsscnptivs enough to relocate In the need of maintenance scurnL*and semis d...r,.p-ant ,f,.
•
D•aa rja,x-t•ra Lra r.f o%d A n.onrfuxl unentalun A layout.Septapurp toga location,North Irmo.reserve 3rsm4i►Id e.:a•:^0 and y„oce..-: -f,,.,:
Kell\oelu. atun poets.Ceanouts.ail o'l e.•cam.!enanes ucce•sl rCm a tncpntpiete Recce'I era,..•-]e -' u.r•.,c,. ai .4 t
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PR �
AUG 1 1 2p023 MASON COUNTY ENVIRONMENTAL HEALTH
A Jaw
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with l comfy that the system has Lt.'en installed in occur-
the septic design stamped'APPROVED"by Mason dance with the septic design stamped APPROVED':'
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 a
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this I further certify that all mformatto contained on this
form and a hod R ord Draw' is ccurate. form and attached Record Qra��),s accurate.
7 07/24/202�t ,.�. ,ill
S,gn re of Installer Dote i r4' -
acob Pettit �S'�°OR 0,z�9���1 .1
A. y.t om• ° F¢�dh
ranted Name of Signet:• r �P 'a . ✓^N 1 J/
MASON COUNTY PUBLIC HEALTH i`4� 51 fP��.1
m e undersigned approves this installation Report and iiir'Ar cy LICENSW CIND DESIGN 4�1
Hi
rd Drawing on behalf of Mason County Public ��„ ��t� " ` ` "=�
I •ii EXPIi s oSiro
all► r.N�lw+ �1- �
S; a!ram I Environmental Health Spociaitst I.,r, ^1
(stamp, signature and date) j/`
THIS FORM MAY t3E SCANNI:U ANU i..r I ABLE FOR PIJBL!C VIEW ON THE MASON COUNTY WEB SITE '•
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