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HomeMy WebLinkAboutSWG2023-00085 - SWG As-Built - 9/27/2023 Ripo SEP 1 11023 Mason County OSS Installation Report i g. 1 RASON COUNTY PUBLIC HEALTH APPLICAN - - 1 ii "O RM . ION Permit Number SWG 2023-00085 Parcel# 32021-58-03044 Applicant Name Bob Robison Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 323 SHORECREST BEACH ESTATES#1 BLK: 3 LOT: 44 City, State, Zip Port Orchard, WA 98366 Installer Name Arrow Excavating Site Address 2081 E Crestview Dr, Shelton Designer Name Arrow Septic Designs INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ D ' ly ® Repair ❑Other System Type Pressure Bgd Pretreatment Type O \ >5 ft.from foundation? - _ - - -- 'Y- - - - ❑ N/A 0 YES ❑ NO >50 ft.from wells? - •�•; O �j� - • ❑ ❑ Z >50 ft.from surface water? • -• �� ! - CI ❑ HCleanout between building and tank? - ;---�,a- - ❑ MI U Tank baffles present? - \- -- - - - ❑ ® ❑ a • 24"access risers over each compartment?- N - El 0 CI N Effluent filter installed?- - ❑ ® ❑ Septic tank capacity (working) 1,250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - IN CI El 1? Check valves installed? - - ❑ ® ❑ O.:( E Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 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? - - ® ❑ El LL. >10 ft. from potable water lines?- - ❑ I El Z- > 5 ft. from property lines and easements?- - ❑ El ❑ ce > 30 ft.from downgradient curtain/foundation drains?- - 11 ❑ 0 in Drainfield level and observation ports present - - El ® ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A © YES ❑ NO • Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman FZQ- 24"access riser(s) and accessible from surface?- - ❑ NI ❑ a. Alarm or Control Panel Installed? - - ❑ PI ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ • ❑ D Cl- Pump installed in ❑ Bucket or UI On Block or ❑ Other n'• Pump Make/Model Liberty 253 ❑ Floats or I. Transducer a Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 5 ft Pump on time 1.9 minutes Pump off time 6 hours Daily flow set at 360 gpd Upcatcd 521nc^8 Mason County OSS Installation Report pg. 2 ABANDONMENT RECOR ParcelD# JZ 62-1" 5f '- 0 3044 Were existing septic components abandcned as part of this project? - - riLYES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES 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&layout.Septicipump 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. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER l 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 a/I information contained on this form and/attached R ord Drawl s accurate. form and attached Record Drawing is accurate. °S/►� /75 nature of Installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH The ne undersr d approves Installation Report510C,349 " g this and PAULA JOY JOHNSON Record Drawing on behalf of Mason County Public .LferiVsEIipESI' Nam.. t Health: EXPIRST i 1 (Z7/z, -22-23 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 Updated 8rz''23118 Dj2GRESN I5�I \ — • — EJALE V D—1 � y _ 1 3 PA�c,Et_4 32fl2.t-S8-03gh`T 203\ E GgESTvtV� 'Pe._ . A 1 � � 21y X40 ' 1 -3 B/R, P-1 • N 1 I t i f A e co wvvti 55 itvteaj 0 • o o g IA I I ; 0 ° jam' 101X451 Pyie$AA.vi • F . oka _ gear w'c - 450 5t �'f' K� � n n� � yo� rt � iyo, L 4,24afeed Rt5v/,je bed r Z , I gtem Ito' Peselpfs,c L __ '5 5 _ _ i t '7a 3 Audio-Visual.A1arm Cleanout n 1200 Gallon Septic Tank .\/ 2-Compartment with Effluent Filter i 1000 Gallon Pump Char-�be: wit • ,�� �./�J t. F74.1 5.:*):,,k, 1 .‘I y/j 51.0.349 '•,�.tj '?a' PAULA JOY JOHNSON k LiafkrbU SIGNMlt `, '� APPROVED $"ZZ C2' SEP 27 2023 MASON COUNTY ENVIRONMENTAL HEALTH . RET