HomeMy WebLinkAboutSWG2023-00310 - SWG As-Built - 11/29/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00310 Parcel # 32006-50-04911
Applicant Name Cresencio Huesca Subdivision (Name/Div/Block/Lot)
Applicant Address 471 E Island Lake Dr Island Lake Shorelands!Block 4/TR C
City, State. Zip Shelton,WA 98584 Installer Name Maples Excavating
Site Address Same Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
I♦ Full System Installation ❑Tank(s)Only ❑ DrainfisId Only El Repair ❑ Other
System Type Sand-Lined Beds Pretreatment Type
>5 ft. from foundation? ❑ N/A Q YES ❑ NO
>50 ft. from wells? - ❑ 0 ❑
/
• >50 ft. from surface water? - K\E-2, ❑ ID
2
F Cleanout between building and tank? — - h-- ❑ I
U Tank baffles present? - ❑ ® ❑
I- 24" access risers over each compartment'h.6y, - ❑ 0 ❑
W Effluent filter installed?- ❑ ❑ ❑
co
Septic tank capacity (working) 1,250 gal Manufacturer Roth
0 D-box water level and speed levelers used? InN/A ❑ YES ❑ NO
QO Manifold/D-box accessible from surface?- ❑ 0 ❑
mZ Check valves installed? - - ❑ • ❑
OQ
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑3 n 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft-from foundation?- ❑ WA Q YES ❑ No
o >100 ft. from wells?- - ❑ Q ❑
W >100 ft. from surface water? ❑ (] ❑
a >10 ft.from potable water lines? ❑ El ❑
Z > 5 ft. from property lines and easements? ❑ . ❑
IX > 30 ft. from downgradient curtain/foundation drains? - . . ❑ ❑
Drainfield level and observation ports present . - ❑ it ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield? ❑ ® ❑
Pump tank setbacks consistent with septic tank? ❑ WA ® YES ❑ NO
Y Pump tank capacity(flood) 1,250 gal Manufacturer Roth
< 24"access riser(s) and accessible from surface? ❑ O ❑
I—
a. Alarm or Control Panel Installed? ❑ I] ❑
2 Control Panel equipped with Timer/ETM/Counter- ❑ 0 ❑
a Pump installed in ❑ Bucket or ® On Block or ❑ Other
O. Pump Make/Model AY McDonald 405011 EFS-110v. 1/2hp i: Floats or ❑ Transducer
2
0.0. Tank draw down 2" in/min Pump capacity 60 qpm Squirt Height 5 ft
Pump on time 2 min Pump off time 6 hr Daily flow set at 480 gpd
Mason County OSS Installation Report pg. 2
Parcel#-520 06— so e?1
ABANDONMENT RECORD
ES 0 NO
Were existing septic components abandoned as part of this project? -
If yes, please describe YES 0 NO
Were all components pumped out and propedy abandoned per WAC240-272A-0300?
RECORD DRAWING
m need of
tivtes and futuredevelopment Typical Record
Thish
is sa permanent Dr record and must ne accurate ayodu asepcfp tank Lo .Nat a ar ti la 3f g and P' o a e I e gs,local wells,waterlines,
Drawings ervecontain: rr rR=s outs an onentation a layout ces!a aeare as I delays final' llatcn aaarn�and lath pennw.
wean.eeaammn ports.aavi<ns,and caner mammnan«access points. l^«-ol=re Record Drawings may a
I
A
Nig Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
1 certify that 1 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 clearedlapproved 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.
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/Signature of Installer Date of
i
Panted Name of Signee ►{n; ail" ,.q
MASON COUNTY PUBLIC HEALTH �1 I t^\
The undersigned approves this Installation Report and ,, g ?�}�
Record Drawing on behalf of Mason County Public �2 pppLA JOY JorlrseN
o.IiDtI StiDIDS81GNPti" i
Health: T EXPIRES>y�5a st,-,-. $ s:.N.T
Qy._,0 ( 1 itst1ZJ EXPIRES tiufa5f �.—r
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Signature of Environmental htalth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND ARAI-LA.8LE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE PM'8Rrrzo1e
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