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HomeMy WebLinkAboutSWG2023-00086 - SWG As-Built - 8/15/2023 - 1 'Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00086 Parcel # 52008-51-00006 Applicant Name HUNTER LIVING TRUST Subdivision (Name/Div/Block/Lot) Applicant Address 500 S E COLE RD City. State, Zip SHELTON, WA. 98584 Installer Name Site Address 160 W LAKE NAWATZEL Designer Name CINDY WAITE INSTALLATION CHECKLIST • Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair p El Other System Type PUMP TO GRAVITY Pretreatment Type >5 ft. from foundation? - - - - - - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? ❑ 0 ❑ >50 ft. from surface water? - ❑ 0 ❑ il Z - Cleanout between building and tank? - - - -- - - ❑ 0 ❑ U Tank baffles present? - - - -- - - _ -. - ❑ 0 ❑ d24" access risers over each compartment? - - El 0 II W Effluent filter installed?- ❑ 0 ❑ Septic tank size 1200 gal --fGlanufacturer SOUND PLACEMENT _ 0 D-box water level and speed levelers used? - - - - ❑ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - - ❑ ❑ ❑ mZ Check valves installed? - - - - -_ 0 ❑ ❑ 0Q Transport Line Size 2" CASED Schedule/Class SCHEDULE 40 Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO >100 ft. from wells? El 0 ❑ —i >100ft. fromsurfacewater? - - - - - - - ❑ ❑ ZW - ye- - >10 ft. from potable water lines?- ff [lr ❑ ❑ > 5.ft. from property lines and easement ''1.4.'�h n 0 a sang-,'���-1--� _,� ix > 30 ft. from downgradient curtain/foundation dra`rrsr're .�- - Drainfield level and observation ports present - - /l- d1 el? ❑ ❑ If 0 ❑ Graveless chambers or 0 Clean gravel used? (cuffck one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistant with septic tank? - - - - - - - ❑ N/A ■❑ YES ❑ NO Y Pump tank size 30°X60" gal Manufacturer ORENCO VAULT Z < 24" access riser(s) and accessible from surface'?- - - . ❑ ■❑ ❑ a. Alarm or Control Panel Installed? ❑ © ❑ * Control Panel equipped with Timer/ ETM i Counter- 0 ❑ ❑ \A n- Pump installed in 0 Bucket or ElOn Block or ❑ Other a Pump Make/ModelLIBERY LH 150 � — _ ❑■ Floats or ❑ Transducer Tank draw down Q. in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time_ Daily flow set at gpd r Mason County OSS Installation Report pg. 2 Parcel # 52008-51-00006 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - 0 YES ❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Q YES El 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 E 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 .) X",rr/ q/ 1 3—40' (af n /s f.4.1 sAT. ) 4/-.'f; T�UA� I, JFO A! C kld a,g e el (9 f h-C/Nrp 4 d /r Nile 6,0r d� ,A-d' c( '' /o/ IS&c.. 4-1v-.B� Q CLD,k. vo1vt r,us�. RIO(4/Op AUG 15 2023 MASON Muni Ty ENVIRON4�ENTAL HEALTH JBw NI 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. el i..e 67-7, , ,. i if../-7 ..- 1.3 . ignature of Installet. r Date qj ( 7 ,, ; lc ce, li Printed Name of Si nee - P 0 g ems' oF,n4sti, �. `),k *40.01: MASON COUNTY PUBLIC HEALTH �P 7.F� _°`�� The undersigned approves this Installation Report and y JStoo418 s� Ro-: d Drawing on behalf of Mason County Public �? LICENSED DESIGNER ea/ tk Exc iutS o5 tOt q/ likA ► j(SZ Sig at ir:c nvironmental Health Specialist Date (stamp. signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated hl:1' '.a 0 I �`����t3c)t Wdtl.Pt Dt,Ve • R �1: i • lam.. ,,r.........--. .1 / • i• . /1 1 1 \� '.4k1 K: , I !(/':: I ,00 -4 i • _1.1: — (411A ...._ Tr- r \L... -pC (t -.. 1`, a A - Z...,... ... , isi '• Al/ q,' ; • 4 P ir 4 14 ti couNr Jii., 1E / ..-- / !.. VRC. p '* MfNTq[H rh 2Vd, . L. fA[ . \.41. 1 0.1 • (.-- .\\‘'s 71 >' N.. I °1 CL c'1 1 n ", � c t , I \\ �^ • k j C � O to COoo ) cn p W N ..a `` Of iy ,.4ry. ,<"� Q X v v -, ' 2, z m u+ m �n i 1 .6• sy W 01 o p1 c m m o x or I • 4 ��eso MIME. 0 ao c 13 w a Q‘ ,% ,\ �;s,,v�/1 •©6 k 9 * m 4 o a 5. 3 "'Cl. o c �/ NSE Esicmt 1. +�✓ 4 ex,HEs of,,,,, ������ 1 ; � .j_ _ { a 7� y �� L �- { v 0 o O 7L' n 3 ° -a d 1 - I 1/1-, (72_ ep ---,.."----• Lii-2. L (" t:3 le.1 10- _ / tit_ - 0 1--------- [ /0/ i 2-v' 1 7U' 1 ". fa' 0 GI tdit) O( /obrokir obs po ds CPkdi`C (eJ -roPe4 le r • Io� P- ti is,Q a i �, I, 1/ ir.i 10041 .1 ` CAir 41.1 �YE.WAITE1 ���f�, so LICENSED DESIGNER 4, VIAmigi k %wok. ii.N. iii o .loom1 EXPIRES USi1O/ 1 1