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HomeMy WebLinkAboutSWG2023-000024 - SWG As-Built - 8/15/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00024 Parcel# 320012100000 Applicant Name NICOLE NORRIS Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 3137 City, State, Zip SHELTON, WA 98584 Installer Name SHANE MAPLES, MAPLES EX. Site Address 101 E SCARLET RD, SHELTON Designer Name ALEX PAYSSE INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type CONVENTIONAL PRESSURE Pretreatment Type >5 ft.from foundation? - /:,#`- ❑ N/A E]YES ❑ NO >50 ft.from wells? - // --- -/�- ❑ Q El >50 ft.from surface water? - 4 -'w- ig © El HCleanout between building and tank? - - - - - ek 0-ftr- -- 0 CI U Tank baffles present? - ❑ a24"access risers over each compartment?- - ,r/; © ❑ `W Effluent filter installed?- © CI Septic tank capacity(working) 1500 gal Manufactu : _ _ HAGERMAN 3 D-box water level and speed levelers used? - - N/A ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - ❑ It ❑ GQCheck valves installed? - - El 0 ❑ m Transport Line Size 2 Schedule/Class SCH. 40 Bedrooms installed (check one) 0 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO >100 ft.from wells?- - ❑ 0 ❑ o W >100 ft. from surface water? - - Cl II CI Z >10 ft.from potable water lines?- - CI IL CI Q > 5 ft.from property lines and easements?- - ❑ © ❑ CI• 30 ft. from downgradient curtain/foundation drains? - - [Pi ❑ Drainfield level and observation ports present - - ❑ 0 ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A © YES ❑ NO Z Pump tank capacity (flood) 1500 gal Manufacturer HAGERMAN ej 24"access riser(s)and accessible from surface?- - ❑ 0 0 aAlarm or Control Panel Installed? - • 0 II ❑ 2 Control Panel equipped with Timer/ETM /Counter- - El I ❑ m a Pump installed in ® Bucket or ❑ On Block or ❑ Other 0. Pump Make/Model ZOELLER/N152 ® Floats or� 0 Transducer 0. Tank draw down 2.25 in/min Pump capacity 65 Height gpm Squirt Hei ht 5 ft Pump on time Pump off time Daily flow set at gpd JI'dcded 8'2'12018 Mir►. Mason County OSS Installation Report pg. 2 Parcel# 320012100000 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 0 NO If yes, please describe: _ Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES 1=1 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 conta;e. Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve droinfield,existing and proposed buildings,!ecation o`wells,waterlines, wells,observation ports,clennouts,end other mantenance necese points. Incomplete Record Drawings may coatu additional delays in Heal Installation approval and related permits. 4 p ri � ft 7 te>Al tb i r 'SO .7 2193 NCOUNT1ti.VI h �v;,r,yrA,ii, a°ai / H Q 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 form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 2,;,.-..— /1//.-t.-,_-- bi Ili, Signature of Installer Date shone 11n416 9 t i t z Printed Name of Signee n "" • Pwti" •i. • MASON COUNTY PUBLIC HEALTH r •.,- The undersigned approves this Installation Report and / st ALEX LOUTS PAYSSE Record Drawing on behalf of Mason County Public . •Leir: 9 (at f.,rili L•J 6A......., S. --( -.2023 Sign to 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 8/21/2B18 , EXISTING DRIVEWAY . P r 1 0 v 7, --, / r AUb t 5 2023 4SON�0JNTY`A VINONIMENTAL HEALTH /1 O / i D JBtW a / �/ / r '`\\ �, !\ / .1 , \ � \ ( I \ \ / EXISTING WELL i // �/ / WELL / \ \\ / / / , I' -----.., / I / \ I � • O� / / �,� 1", /!/ APPROX. �f FUTURE / r / -, HOME 4 INSTALLED / DRAIN FIELD / , 1 0 —/)/\ SEPTIC & PUMP TAN kS W/ PANEL / ...:..S.....L° I ,.I, L-- i1 1I. o •;,. .Q +.mot_ • I16 28.I, `. 1 .. • ...;,, ---- -,—,,;.4\---- F? ',goo I,, ALE POW .. .�, , ,,N RECORD DRAWING PIONEER DICGINC, INC. PARCE #:301-21 R NORxlS TEST HOLE L TEST HOLE 2: 1 LJI H��1.L 3: PAR CUSTOMER: N1C 1 U0000 0 3o cst 0-26 cv o 2b GSl 30+GT&H2O 26+MOTT/COMP 26+MOTT/COMP SEP-1 IC DESIGNS ADDRE 101 E SCAR1Ef RD ROOTS TO 30 ROOTS TO 26 ROOTS TO 26 3083 E MASON BENSON RD. GRAPEVIEW,V,A 98540 DEIGNER ALFX L PAY.SSE OIEDLOOBt:TIN VS FELT A SLIMY.REFEREWCS NQ U°E MC NJ PLT�CMM)1'PROVR�EL RUTS OR SURVEYS,F ED MEISURENENTS MID COUNTY GIS DESIGN INTENDED FOR SEPIIC OFFICE 360 426 1803 FAX 360 427 2353 SHEET: AM LE C SCALE 1'-100. MMPDTSEESN T=CY RET2ZI S GNEERV NELOOT R•EESPO Nw FE S IACN5T UNTPOE UTOO SEPT.:COMPONENTS