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HomeMy WebLinkAboutSWG2023-00198 - SWG As-Built - 9/27/2023 ITPO' Mason County OSS Installation Report pg 1 SEP 1i ZO23 M • .ON COUNTY PUBLIC HEALTH APPLICANT • - . 1►3,-MAT •N ---Hafterar Permit Number SWParcel G 2023-00198 # '-50-00003 Applicant Name Terrence&Ingrid Clancy Subdivision (Name/Div/Block/Lot) Applicant Address 2638 169t h Ave SE Pickering Passage F&G Tracts City, State, Zip Bellevue,WA 98008 Installer Name Bamford Septic Repair LLC Site Address 401 E Osprey Ln, Shelton Designer Name Arrow Septic Designs INSTALLATION CHECKLIST II Full System Installation 0 Tank(s)Only 0 Drainfield Only Q s Rep ❑Other System Type OSCAR X02 Pretreatment Type x0 L c . >5 ft.from foundation? - -_- - ❑ N/A ❑■ YES ❑ NO >50 ft.from wells? - SPt -zf� - ❑ NI 0 • >50 ft. from surface water? ; A--� 0 NI 0 Z 0 HCleanout between building and tank? - `‘L -'' ❑ ❑ U Tank baffles present? \ c? -S ❑ 0NI a 24" access risers over each compartment?-- \- -- - - _- - ❑ © 0 ■ 0 W Effluent filter installed?- ; - ❑ to Hagerman Septic tank capacity (working) 1,500 Al Manufacturer 9 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES NO J 0 00 Manifold/D-box accessible from surface?- ❑ 0 m 0 Z Check valves installed? - - - - 'ht -i2u" -? i- k0 5 0 oa 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 0 6 0 Commercial/Other >10 ft. from foundation?- - ❑ N/A Ei YES ❑ No 5e e, y,3a, v er 0 0 >100 ft. from wells? 0 ❑ w >100 ft. from surface water? - - El II 0 Ez >10 ft. from potable water lines?- - ❑ ❑ 0 Z > 5 ft. from property lines and easements?- - 0 El 0 (t > 30 ft. from downgradient curtain/foundation drains?- - © ❑ ❑ 0 (U ❑ Drainfield level and observation ports present - ❑ 0 Cravele3s chomber3 or ❑ Clcart gravel used? (ci ieck re) 0 Proper cover installed over drainfield?- - 0 El Pump tank setbacks consistent with septic tank?- - ❑ NIA ❑ YES ❑ NO Pump tank capacity (flood) 1,500 gal Manufacturer Hagerman Z0 ct 24" access riser(s) and accessible from surface? ❑ I El Alarm or Control Panel Installed? - - 0 a 2 Control Panel equipped with Timer/ ETM /Counter- - 0 IN 0 d Pump installed in ❑ Bucket or ❑ On Block or 0 Other on bottom of tank a. Pump Make/Model AY McDonald E-30GPM 0 Floats or 0 Transducer a E — ft Tank draw down -- in/min Pump capacity 30 gpm Squirt Height Pump on time 30 seconds Pump off time 3 minutes Daily flow set at 720 gpd Jpce:ed 6.2 231e I , Mason County OSS Installation Report pg. 2 Parcel# 22 `��- SD_ occo3 ABANDONMENT RECORD Were existing septic components abandoned as partof this project? - YES ❑ NO I .c& If yes, please describe: O - k c ''"`- .02`AA-wcol �tet D. E.ak &� � 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.Septidpump tank location,North arrow.reserve drainfield,existing and proposed buildings,location of wells.waterlines, wells.observation ports,deanouts,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 /certify that I installed the system in accordance with 1 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 l further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Recor Drawing is accurate. CY; f 0 I i 23 hel t Signature oflnstalle Date Printed Name of Signee ,t, °11.F MASON COUNTY PUBLIC HEALTH :y ' 51;>c:,4• • : 1` The undersigned approves this installation Report and '`fV PAULA JOY JOHNSON '. A ���ivs�a�a�grc��.. � Record Drawing on behalf of Mason County Public �- ca " "�� Health. EXPIES /_, li- 7fZ3 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 621i2Cr8 Al ... /u 'Ck >46 2;u l 1:C , has S r, v ltrenCt tingrid Clan.. _ N N ffCCt1 Zztl 3-50-00003 1 r Ln C Ei: 1“-- yo . .51, . • r---r-----,=====Sa htea- of' 10 $p �1'cOk H 1 c y 0 to �o �° v, o. ., i► .�- 3. • i T i- -\- fils: `v..�� - g .crra�,yy, •-'4'. 5'U0349 V) �:�' PAULA JOY JOHN$ON�•`' �rt�`��a5 Z��r\ 1 EXPIRES On l r-Yi {17 vi4G 2- 5&-,, ` . fiouS? aazz. Rot-,F-ZeS ! Ex:S-F. Go. 1 -I ----- APPROVED 1 SEP 2 7 2023 o • ® y\ MASON COUNTY ENVIRONMENTAL HEALTH a C6)oso. RET 0 7'�c o Q 1 0; © Q (�CS(cY YS o 134233.- '4;5'-1.te 1 CS-cc.P.r.-�+a') i IC._ _ Y rr O Control Panel with�sis� s is / , ON 1,o0o Get 2- --c `4'-W: STA.: 'et,-.—f. ` mac' O3 1,500 Gallon Septic/Aeration Ta_ . tee- j 2-Compartment with air diffuser ! ioG` Cot�lMunM vt • who O15-00 Gallon Clarifier/Pum•P Tank 2 CQrr,parrment i 1 • OHeadworks a: O. •\ 0 OSCAR X02 Mound Drainfield