Loading...
HomeMy WebLinkAboutSWG2018-00322 - SWG As-Built - 10/17/2023 LEH Mason County OSS Installation Report pg. 1 Ke_ MASON COUNTY P BLRE f1llJA1JO ; APPLICANT/PERMIT INFORMATION RFrFIVED .--- Permit Number SWG 2018-00322 Parcel # 22017-50-00107 Applicant Name Pam Carney Subdivision (Name/Div/Block/Lot) Applicant Address 321 E Annas Way Timberlake Division:2 Lots: 107& 122-A City, State, Zip Shelton,WA 98584 Installer Name Mikkelsen Septic Site Address Same Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type NuWater >5 ft.from foundation? 0 NIA El YES ❑ NO >50 ft. from wells? - ® ❑ ❑ Z >50 ft.from surface water? ❑ ❑ f Cleanout between building and tank? 2 - - -- ❑ ❑� ❑ U Tank baffles present? - - ❑ X ❑ P 24" access risers over each compartment? ❑- ❑D ❑ a IE ❑ at Effluent Effluent filter installed?- 2-SW ❑ Septic tank capacity (working) NuWater gal Manufacturer Hagerman G D-box water level and speed levelers used? - © NIA ❑ YES ❑ NO (Ili/ Manifold/D-box accessible from surface? ❑ 0 ❑ RIz Check valves installed? - ❑ S ❑ cio Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) E 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation? ❑ NIA N YES ❑ NO G >100 ft. from wells? IN ❑ ❑ W >100 ft. from surface water? In ❑ ❑ >10 ft.from potable water lines? ❑ ❑� 0 > 5 ft.from property lines and easements?- - ❑ II ❑ > 30 ft. from downgradient curtain/foundation drains? 0 ❑ Drainfield level and observation ports present - ❑ II ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield? ❑ ❑� ❑ Pump tank setbacks consistent with septic tank? ❑ WA 10 YES ❑ NO Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman $ < 24" access riser(s) and accessible from surface? ❑ El ❑ F d Alarm or Control Panel Installed? ❑ I] ❑ j Control Panel equipped with Timer/ETM/Counter- ❑ ® CI a Pump installed in © Bucket or El On Block or ❑ Other 2 Pump Make/Model Liberty 250 El Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 28.5 gpm Squirt Height 5 ft Pump on time 2 Minutes Pump off time 6 Hours Daily flow set at 240 qpd uplated E 2112018 Parcel# 'Z°i1��1 - S Mason County OSS Installation Report ABANDONMENT RECORD _ _ _____ _ 0 YES �- NO Were existing septic components abandoned as part of this project? - - --- " - YES ❑ NO If yes, please describe: Were all components pumped out and propetly abandoned per WAC246-92A-0300? RECORD DRAWING This cenem record and must be accurate and descriptive enou9h to re-locate need of maintenance iiu and future development Typical Record ora+nye�^ oa.nremaanld oaea fl nc seoe o c tank location,Not. etl rw existing dproposed Sol a,location of u , atem�S. well:,oo.ewam^ports.sea^oo+,and other maintenance access Points. Incomplete Record Draweamar create addition&delays final installation aproval and related permits . W.Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNER/ENGINEER INSTALLER I certify that 1 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 1 further certify that alle informationdrawicontainedsac on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 4�CZ�n � ' ')717�7/%; ,.r�o v� Bt� nature of In eller ' Date 7 �...44 1aT-"-- ` .�R a . na , h.0J r Printed Name Of ;goes • MASON COUNTY PUBLIC HEALTH Z vAUlAslOn!'"NsoN._�I f The undersigned approves this Installation Report and }`:1P.LtoEN`Etj"\;f,'9alir Record Drawing on behalf of Mason County Public 1�i'cSS-5�s` bars Health: 7-3 --Ls-- Zs (stamp, signature and date) Signature of Environments'Health Specialist Date updated aavzo+a THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 5 a INA-NER. i ' i>3i. DECK 7(..y -�000 •' - Houze \ L5L • d •-4 4 APPROVED DRAvEw11 ✓ OCT 17 2023 fd J .i504 COUNT?'E5V1RC1 YE�1i4L HE4LTH RE? V - i r . r ' r DC) s / i.,� mi / , / In 1 \w / 4 e 11�. •` {lMI 1 • d 5,ade + 1`0 ao1 .. 0 to 'toao k0 . ill, i �posi.a aao -t-so—oolo-1 ^ ' ' pti321 E Axras IA) 'UCiJ " �LE;g41H�t � jL-rthi4»sSNi 0Audio-Visual Alarm -7- Z,S.',3 02 Cleanout © NuWater BNR-500 ATII Tank 0 1,000 Gallon Pump Chhnber 0 Valve Control Box .