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HomeMy WebLinkAboutSWG2023-00203 - SWG As-Built - 10/2/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00203 Parcel # 32025-50-00904 Applicant Name Angela & Brad Murray Subdivision (Name/Div/Block/Lot) Applicant Address 30 E Gosnell Ln Mill Creek Park (Unrecorded) - City, State, Zip Shelton, WA 98584 Installer Name Maples Excavating Site Address same Designer Name Arrow Septic Designs, Inc I INSTALLATION CHECKLIST l Drainfield Only $ Repair Q Other Sand Filter Replacement ❑ Full System Installation ❑Tank(s)Only ❑ Sand-Filter System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - ❑ NIA Q YES ❑ NO >50 ft. from wells? - - ❑ ❑ ❑ • >50 ft. from surface water? - - © E ❑ z ❑ Fa- Cleanout between building and tank? - ❑ ll• Tank baffes present? - - ❑ E D d 24' access risers over each compartment? - - ❑ W Effluent filter installed?- ❑ i ❑ U) existing tank capacity (working) 1,500 gal Manufacturer 0 D-box water level and speed levelers used? - - ri N/A ❑ YES ❑ NO Q O Manifold/D-box accessible from surface?- - ❑ CI ❑ 0?2 Check valves installed? - a)c f V` - - - - ❑ 0 ❑ oG Transport Line Size 2" Schedule Class 40 Bedrooms installed (check one) ❑ 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? - ` ❑ ❑ u. >10 ft. from potable water lines?- Pi ❑ ❑ Z Q > 5 ft. from property lines and easements?- - - - - El f > 30 ft. from downgradient curtain/f ion drains? - ❑ ❑ ❑ Drainfield level and obs on ports present - - ❑ ❑ ❑ ❑ Gravel ambers or ❑ Clean gravel used? (check one) er cover installed over drainfield7- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Existing z - ❑ .et 24' access riser(s) and accessible from surface?- ❑ I— n. Alarm or Control Panel Installed? - - ❑ © ❑� Control Panel equipped with Timer/ETM /Counter- - ❑ ® ❑ D Cl_ Pump installed in ❑ Bucket or 0 On Block or ❑ Other 2 Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer a Tank draw down 3" in/min Pump capacity 60 gpm Squirt Height 8 ft Pump on time 1 min Pump off time 4 hr Daily flow set at 360 gpd ..,^,cw.a F.R1,20:8 `- DOcto`•4- Zc�2.S- 5° _ Mason County OSS Installation Report pg. Z Parcel# ABANDONMENT RECORD II YES E NO Were existing septic compone°ntsabanden as of this� v project? ��s-� J If yes, please describe. Sam-gt YES [] NO Were all components pumped out and properly abandoned per WAC246-272A-0300? 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 Dings contain: Craintield 8 marcfolC onenta;ion b layout.Septiupump tank North arrow,reserve crainfield,e>estng and proposed buidings•location of wells,waterlines, in 5rai installation approval and related permits.ocaLon, was.observation ports,deanouts,and other maintenance access points. incomplete Record Drawings ray create additonal delays I t __Q__,(R\Ck5 , -61,`r .,__ :" --S--4--°V- S---- iri -k...'?5 IN Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that 1 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. /'Signature of Installer Date ' n .G JJ t 5 Q: �LC••�ir�` (il l .0, .A. •.��rj, • �ry Printed Name of Signee " ••• MASON COUNTY PUBLIC HEALTH j?.: �.1 The undersigned approves this Installation Report and J'�; PAULA JOY JOfINSON y�f� 00343 Record Drawing on behalf of Mason County Public 1 ICENSl:f rkS! NE'ft" if. Health: EXPtit 5� lr �c,.a Q,Cr-N(2-r(1) 5C)(11 0RZ/Z3 I -t - Z3 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uocatee 8rz:20:8 it A-s- )L,kz -- 0 ck\Kw\e. `-\'"N\. . 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