HomeMy WebLinkAboutSWG2023-00354 - SWG As-Built - 9/27/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC
HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2023-00354 Parcel# 32127-51-00140
Applicant Name Carol Sexson Subdivision (Name/Div/Block/Lot)
Applicant Address 1014 C Ave South LAKE LIMERICK 2 TR. 140
City, State, Zip Edmonds, WA 98020 Installer Name Maples Excavating
Site Address 430 E Penzance Rd, Shelton Designer Name Arrow Septic Designs
INSTALLATION CHECKLIST
111 Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑ Other
System Type Shallow Pressure Pretreatment Type
>5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ No
>50 ft. from wells? - - U] ❑ ❑
Z >50 ft. from surface water? - - 0 ❑ ❑
N Cleanout between building and tank? - - ❑ I
O Tank baffles present? - - ❑ 0 ❑
P 24" access risers over each compartment?- - ❑ 0 ❑
a ❑
W Effluent filter installed?- - ❑ ❑
r.n Hagerman
Septic tank capacity(working) 1,000 gal Manufacturer 9
0 D-box water level and speed levelers used? - - 0 N/A 0 YES ❑ NO
�O Manifold/D-box accessible from surface?- - El 0 ❑
LL
CO Check valves installed? ?u",`1so } - ❑ ® ❑
O Q 40
2 Transport Line Size 2 inch Schedule/Class
Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑ 6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO
0 >100 ft. from wells?- - 0 ❑ ❑
W >100 ft. from surface water? - - 0 ❑ ❑
u. >10 ft. from potable water lines?- - ❑ ❑ ❑
z > 5 ft. from property lines and easements?- - II El
rt > 30 ft. from downgradient curtain/foundation drains?- - • ❑ ❑
0 Drainfield level and observation ports present - - ❑ ® ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A U] YES ❑ NO
• Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman
Z - El ❑
Q 24" access riser(s) and accessible from surface?
I`
a Alarm or Control Panel Installed? - - ❑ 0 ❑
2 Control Panel equipped with Timer/ETM /Counter- - ❑ it ❑
m
n- Pump installed in ❑ Bucket or 0 On Block or ❑ Other
O.• Pump Make/Model Zoeller N152 ❑■ Floats or ❑ Transducer
EL
a Tank draw down 2.1 in/min Pump capacity 40 gpm Squirt Height 8 ft
Pump on time 1.5 Pump off time 6 hours Daily flow set at 240 gpd
Updated 8,21,2018
Mason County OSS Installation Report pg. 2
Parcel# 321 2:1 ^ 5t- Obl O
ABANDONMENT RECORD
11 YES � NO
Were existing septic components abandoned as part of this project?
p lA a--v\.> eGo mtyliSS"kav1 ed n1 at
D p ES
If yes, please describe. j4(DES El NO
Were all components pumped out and properly abandoned per WAC246-27?A-0300? ' `tt'"
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 Recorc
Drawings contain: Drainfieid&manifold or.entation&layout.Sep cdpump tank location,North arrow,reserve crainfield,etdsting and proposed fi b buit inon approvaloonandfwells,waterlines.
permits.
wells,observation ports.deanouts,and other maintenance access points. incomplete Record Drava s may create additional delays
VRecord 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.
/� /% - Oct c3/_ 23
Signature of Installer 1 Dafe 1 4
Printed Name of Signee •p , .,k
MASON COUNTY PUBLIC HEALTH r1,1. II
G�' 4 9
The undersigned approves this Installation Report and PAULA JOY JOHNSON
Record Drawing on behalf of Mason County Public �-J LICE SEg1:li iGNEtt '
Health: acea. b7
C-F)11 1 t2-7 l'2; q- Lt-'1,S
Signature of Environme al Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ,;pcatec 8121 2018
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1 1000 Gallon Septic Tank
U 2-Compartment with
—,-- `Z.t.h { / Effluent Filter
`/ P-'`.,,e& O 1000 Gallon Pump Chamber
OValve Control Box
APPROVED
o SEP 2 7 2023
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