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Home My WebLink AboutSWG2022-00236 - SWG As-Built - 10/25/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00236 Parcel # 22104-43-50300 Applicant Name Michael Lewis Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 71 City. State, Zip Allyn, WA 98524 Installer Name Maples Excavatiq Site Address 381 E Benson Ridge Rd, Grapeview Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST I. Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Othe- System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? ❑ N/A . YES ❑ NO >50 ft. from wells? ❑ ❑D ❑ Z >50 ft from surface water? MI ❑ ID H Cleanout between building and tank? - ❑ 1 ❑ U Tank baffles present' - ❑ 10 ❑ P • 24"access risers over each compartment?- ❑ ❑� ❑ W Effluent filter installed?- ❑ ❑� ❑ N Septic tank capacity (working) 1,250 gal Manufacturer Hagerman O D-box water level and speed levelers used? • N/A ❑ YES ❑ NO ,O Manifold/D-box accessible from surface?- - 0 M ❑ mZ Check valves installed? QL` ` - ❑ 0 ❑ 0< S Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑� 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- ❑ N/A Q YES ❑ NO 0 >100 ft. from wells?- - ❑ ❑l ❑ W >100 ft.from surface water?- - ❑� ❑ ❑ Zr >10 ft.from potable water lines? - ❑ • ❑ QZ > 5 ft from property lines and easements?- - ❑ ❑] ❑ K > 30 ft. from downgradient curtain/foundation drains? - ❑ MI ❑ O Drainfield level and observation ports present ❑ 1.1 ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover instal'Ied over dreinfield? ❑ 0 0 Pump tank setbacks consistent with septic tank? ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1,250 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface? ❑ 0 ❑ ~ a Alarm or Control Panel Installed? - ❑ 0 ❑ • Control Panel equipped with Timer/ ETM iCounter- ❑ Q 0 d Pump installed in ❑ Bucket or Q On Block or ❑ Other d Pump Make/Model Zoeller N152 a Floats or ❑ Transducer 0.0. Tank draw down 2" in/min Pump capacity 45 gpm Squirt Height 6 ft 0 Pump on time 2.6 min Pump off time 6 hours Daily flow set at 480 gpd opGnoo sa'ors 22104-43- So3QD Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD JIII��_ CI YES ,NO Were existing septic components abandoned as part of this project? TTT If yes, please describe'. ❑ NO Were all components pumped out and propedy abandoned per WAC246-272A-03009 - ❑ YES RECORD DRAWING ant Typical Record ['m is a perm record and must nbee accuratelayout.you eocnipum tank hto at o,Nort m we nser e e m it ems e a andiproes ana IUNre gs,Lo tm w um, rank IoraCOM1 NorT aa0w,re anfitla,ensEnS end pmpnsN amkNAs IomOm(rsvelli,waretlNes, was,ob amecn orrtii.don mmand errnante ana cess coots. Incomplete Record Di-sings may create aAAtonal delays ir,final installation approval and related permits. was,observation peM,tleenur4 and other moimman¢acxss x� � v — 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 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. 1� 1�� OS/Irk/27) Signature of Installer Oat A -9 /kLNi k .C5 r �3s Printed Name of Signee +r �f +'f)- MASON COUNTY PUBLIC HEALTH r\.r x;,•. ail The undersigned approves this Installation Report and . ' '��°I� Record Drawing on behalf of Mason County Public /,p PAL"-n JOY uor+PEON '. t L(CENS b#SIGNER_ 1 Health: �.�sS�tsYSPx-N "S- .�NZ EXPIRES !Mr yvvi l alz�h - z44-za Sign tura ofEnvimnme tal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 'AP'e'Sat 2016 l-c (Quit 1\ 1' Rev: Mi(hwrl LewiS PArorl# 2210q- if 3- 50300 0 .Audio-Visual Alarm - 0 i e SerISON (Ridyr Rd Cleanout S(git: l°= fOQ 0 1250 Gallon Septic Tank ° To no 15° 200 - 2-Compartment with Effluent Filter l5) 3'x 59' prpniary r j// 012 SO Gallon Pump Chamber drainRrld -}reVICktS U,' a„ -37.e�� OS Valve C9$trol Box 4 Ol. W fe5(fu( . t 1h6,41/0141/1 29, 3. a,iv. .gi-(1 � V, Pl IILAJGY JO4NSGM1 �\ ��ScvUJ$ i3 ri`SI vEYt ' ny a ' E.aars r,si SS •6 i se ' , �omrnun C. W(II og APPROVED ` °CT 25 2023 ck1` 4 ,... ,,,_ aSCS GauSrl EVV1kObMENi4:HEALTHRET — L.-- - c ic_ NI /a9� It bo• Earrxn+ _ g(hs / c. s - - / s