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HomeMy WebLinkAboutSWG2023-00183 - SWG As-Built - 9/27/2023 / Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00183 Parcel # 22005-52-00055 Applicant Name Michael & Lori Lillie Subdivision (Name/Div/Block/Lot) Applicant Address 2800 E Phillips Lake Loop Phillips Lake/ Div 3/ Lot 55 City, State, Zip Shelton, WA 98584 Installer Name Mason County Excavating Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST • Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑■ Repair ❑ Other System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ Z >50 ft. from surface water? - - ❑ ❑� ❑ N Cleanout between building and tank? - - ❑ E] ❑ U Tank baffles present? - - ❑ ill ❑ a 24" access risers over each compartment?- - El ❑ ui W Effluent filter installed?- 8��_soo I ❑ Septic tank capacity (working) NuWater gal Manufacturer Hagerman o D-box water level and speed levelers used? - - 111 N/A ❑ YES ❑ NO OO Manifold/D-box accessible from surface?- - b ' - ❑ .10 QQ Check valves installed? - - El • ❑ E Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑� 2 4.3.. _0 4 ❑ 5s❑_6_ ❑Commercial;Other >10 ft. from foundation?- r)�1 ZL H� -1' .J _{ I�', N/A 0 YES ❑ NO >100 ft. from wells?- "'- L. III ❑ ❑■ J >l00 ft. from surface water? - I SEP-1-`--�3 - - ❑ CI ❑ >10 ft. from potable water lines?- ❑� ❑ ❑ Z > 5 ft. from property lines and easements?- - - -e--- -_ , 0 ❑ Q > 30 ft. from downgradient curtain/foundation drains?- ` - J ❑ ❑ Drainfield level and observation ports present - - ❑ X ❑ ❑ CravcIc3s chambers or ❑ Chan gravel Used? (chet,k onc) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer ___ _, _Hagerman -traffic rated < 24" access riser(s) and accessible from surface?- - - - -. - ❑ . ❑ a. Alarm or Control Panel Installed? - - ❑ I ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ I ❑ D n- Pump installed in ❑ Bucket or ❑ On Block or ® Other on bottom of tank a Pump Make/Model Sta-Rite Step20-03, 115v,1/2hp,20gpm ❑■ Floats or E El Transducer a_ Tank draw down 2.25"/ 10 min in/min Pump capacity 4.3 gpm Squirt Height -- ft Pump on time 4.66 min Pump off time 1.9 hr Daily flow set at 240 gpd updated a71rz0te Mason County OSS Installation Report pg. 2 Parcel# 22-09S S t — ©CpaSIS ABANDONMENT RECORD YES El NO Were existing septic components abandoned as part of`this proje c � ����� If yes, please describe: 0 Lk- `-\ k- _� �` Th NO Were all components pumped out and properly abandoned per WAC246-272A-C300? - - YES 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 locaton.North arrow.reserve ld. ng and Drawings contain: prts. eld&manifoldadother ation 8 layo t.Se points. ncomplete Record Drawings may creater eaddi5 al delays in proposed installation approval and related permits. wells.observacon por's,dean0uts,and other maintenance access poi^ I—Q-C)-- Alej€°11CL R 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 1 further certify that all information contained on this I further certify that all information contained on this form and atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. Signatture of Installer 1/ Date Printed Name of Si nee •"���h Sig nee COUNTY PUBLIC HEALTH pir 7.10:��' The undersigned approves this Installation Report and n -, ( ,, ,r .�� Record Drawing on behalf of Mason County Public ` st J �`,r. �' PAULA JOY JOHNSON ' ill Health: ��' • a_'�iCSi Ett'c�' (/'yyl WIRES 1-/ e-JtrAiVel b '� / /i - (1-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 updated 8/2.2o1a Aii- c_,1.:. L xev: Lor: Q M iCkaif L;11 ;e O Audio-Visual Alarm ?Grr1(#22Q65-52-60055 ,,, ?t,\;l101.0 S La K2 O Cleanout 22100 E ?I. 11;f1 �q kc t ors p ti ® NuWater BNR-500 Pretreatment Tank :y 1 k F Gt. - 'k/i^o;•cc.•E-.pww.fit...;ate,-tr+.4„ r, 1,000 Gallon Pump Chamber- �,,) • t , c ti F�Q� I O Subsurface Drip System Headworks — - - 0 15 30 '15 b° - - — © N.es�w�S Q= -T•e S-t f- o I{ • it, i ,5-.57k -....4, #1 ", 3L5," LS4 loo+S. 1 ii,<-•-i) N _i a.: �C 1 Ot RA! `3. -i-Q COY . `rf J' �� lig 01 15 Y7Z • J. i 1,:k';:?PAULA JOY,JO9 HNSON Q. 4g •MGNE(- EXPfRES 151 � .4;-i-N 4% ...., wo r Ft o+ i 4rub I ' t4.st � I I i {_t —•" . — — — 7bRt-E well! I—i :APPROVED i--} a SEP 2 7 2023 Dry 6 i `— ,I. — 307. S!Opt �' MSQl COUNTY ENVIRONMENTAL HE ALTH ,-- " N ,SET * Wa+Cikty\e -to b.e L. '= DcCk I ` _ St-eeved evvcovvv i cf.. �ILV 1 Rrt wall .\ 1 N. 20' Excs+. Ex5-tihq t >nk ��t� a - O t zB J - re hn v v�d .o ■ 1 5�a lX('S-f-i h a drgi h f- e l ei i r 0 fa be abpihdo i e d. propoSt� 65 • 2Lex7.4• , aro.g-e f Col. E Ph; ilifS Lakf Loa? Rd