Loading...
HomeMy WebLinkAboutSWG2023-00340 - SWG As-Built - 10/10/2023 or Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIFOR ATION Permit Number SWG 2023-00340 Parcel# 22030-32-90011 Applicant Name Dave Hooker Subdivision (Name/Div/Block/Loh Applicant Address 5230 SE Arcadia Rd TR 1 OF NW SW"LOT: 1 OF SP#2399 City, State, Zip Shelton,WA 9584 Installer Name Hanson Excavating Site Address same Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? ❑NIA 0 YES ❑ NO >50 ft.from wells? - 0 0 ❑ 2 >50 ft.from surface water? ❑ 0 0 < Cleancut between building and tank? ❑ 0 ❑ ~ ❑ 0 ❑ O Tank baffles present? - H 24"access risers over each compartment? ❑ 0 ❑ O. Effluent filter installed? ❑ 0 ❑ N Hagerman Septic tank capacity(working) 1,200 gal Manufacturer 9 G D-box water level and speed levelers used? 0 NIA 0 YES ❑ NO J pu. m 0 Manifold/D-box accessible from surface? � - ❑ 0 Z Check valves installed? Viz—wee ❑ 0 ❑ Ci< 40 2 Transport Line Size 2 inch Schedule/Class Bedrooms installed (check one) 0 2 0 3 0 4 0 5 ' 0 0'). 0 Commercial/Other >10 ft.from foundation? ❑ NIA I. YES ❑ NO a >100 ft. from wells?- ❑ 0 0 W >100 ft. from surface water? ,n-"J- - ❑ 0 ❑ a >10 ft from potable water lines? ❑ 0 ❑ Z > 5 ft. from property lines and easements?- �tQ,6J ❑ 0 ❑ cc > 30 ft. from downgradient curtain/foundation drins?- - -1 0 0 ❑ • Grainfield level and observation ports present - -if ❑ © ❑ 0 Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield? - 0 0 ❑ Pump tank setbacks consistent with septic tank?- ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z 0 0 0 < 24'' access riser(s) and accessible from surface? ~ Alarm or Control Panel Installed? - ❑ NI 0 a• Control Panel equipped with Timer/ETM /Counter- ❑ II 0 ? 1 Pump installed in ❑ Bucket or ® On Block or ❑ Other a E Pump Make/Model Liberty 280 0 Floats or 0 Transducer CL a Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 4.5 ft Pump on time 1.25 minutes Pump off time 6 hours Daily flow set at 240 gpd xae na Mason County OSS Installation Report pg. 2 Parcel# 9D0 ABANDONMENT RECORD YES NO Were existing septic comRonet�nts abandoned as part of this protect9YYN �""M id �V2i✓1�] d a.lOn.1.Aaldrad If yes, please describe. v�IX A—a-A/ LISS I One r 0 lam-. YES NO yl Were all components pumped out and properly abandoned per WAC246-272A-0300? Y' 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 -ypical Record Drawingsern Orainfieldflmenan on en y p tank location.e " crainfleiC.ecSOng ana proposed A gs,location of wets,watalines wets.observation ports.reanmh.and other maintenance access po.r s. ix . Llere Record Drawsios may create add.onal delays n final installason apncsal aid related p ermits.CLC Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I 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 I further certify that all information contained on this form and attached Record//co/ Drawing is accurate. form and attached Record Drawing is accurate. g anateerL l D l 0123 yr Sig me of Installer DAte G Jared Hanson Printed Name of Signee MASON COUNTY PUBLIC HEALTH is •u BN a� L The undersigned approves this Installation Report and " 9 PP P Ham.. stud±as '.,S1.`k/}, Record Drawing on behalf of Mason County Public r'O., PAULA JOY✓o iGN t Health: �z�ECbE "iGN assxz� ExRRES a 1 / (O —((-23 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBJC VIEW ON THE MASON COUNT°WEB SITE Lpda.ee d1i2C'.a __-- S a CAS \ A- °L<I) tt 3',C' 1 Sti^r ' jC=YEN' I 1 I D2 I ieAvioE L f r.0,L5C WELL V) -fie oia.r....< 'I© I N d n-o c ce; • 0 S bit o1' -Wee C ltt z . .J! icy 1 y —= {Z PAULASJCY JOHNSON c�"�i„?1 ' .j:efs� nEsiaira-.cc EXPIRES AP.2*. : NI •mr . to - l1—z3 I i5� 3x4D' P"' ,.A r '�d cr Ln.h05 dvam c \ �© g' 6c wtt'^ gcsv re X,yJs 11eq: Sc 17 .1"=50 a u� 0 25 So 15 '.00 !' !� C1ez-ou_ AS oCKR t 20 Galion aen�c Tank � / f 2 Co armae with Q�r L�t103C-32'g00 _ � e ;� 51 0 SE C{'e0i �OF e r'1 _COO G oy a�-.,b Chamber ndace Co-_-01 Box (� ! „v-ta:,.. okra.`, —Neu) Q u lcS- a_sooactoned D,f,