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HomeMy WebLinkAboutSWG2023-00230 - SWG As-Built - 10/17/2023 rT OCT 1 1 202J Mason County OSS Installation Report pg. 1 mAS N COUNTY PUBLIC HEALTH APPLICANT! P RMITIA4gOW IATIO Permit Number SWG 2023-00230 Parcel# 22018-51-00067 Applicant Name Zenith Goup NW, LLC Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 1708 Timberlake Division: 1 Lot:67 City, State, Zip Rochester,WA 98579 Installer Name Bamford Septic Repair Site Address 51 E Carr PI W Shelton,WA 98584 Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only 111 Drainfield OnlyReair Other upgrade 2 to a BR ❑ P System Type Gravity Bed Pretreatment Type >5 ft.from foundation? - ❑NIA ®YES ❑ NO >50 ft.from wells? - - 0 0 0 2 >50 ft. from surface water? - - - -"' © 0 0 Q Cleanout between building and tank? -- ❑ IN ❑ f- r' 0 O Tank baffles present? - If T-t' �':- - • 24" access risers over each compartment?-0- 0 II ❑ W Effluent filter installed?- 1,` -"- -- ❑ ® ❑ N Septic tank capacity(working) 1,200 _gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? . El N/A NI YES ❑ NO DJ O Manifold/D-box accessible from surface? - 0 0 ❑ LL m= Check valves installed? 0 0 EN OQ 4 Schedule/Class 3034 f Transport Line Size Bedrooms installed (check one) Li 2 0 3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- . ❑ NIA OYES ❑ NO O >100 ft. from wells?- In 0 0 W >100 ft. from surface water? In 0 0 it >10 ft.from potable water lines?- ❑ IN ❑ Z >5 ft. from property lines and easements?- 0 0 0 C > 30 ft. from downgradient curtain/foundation drains? PI ❑ 0 o Drainfield level and observation ports present ❑ MI ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed overdrainfield?- 0 ® 0 tank setbacks consistent with septic tank? ❑ N/A ® YES No Y Pump tank c ' (flood) gal Manufacturer Q24"access riser(s)and a ible from surface? ❑ ❑ ~ a Alarm or Control Panel Installed? - ❑ ❑2 Control Panel equipped with Timer I ETM/Cou ❑ ❑ ❑ -- - 7 ❑a Pump installed in ❑ Bucket or ock or 1 0 Pump Make/Model ❑ Flo or ❑ Transducer 0. a Tank draw inimin Pump capacity gpm Squirt Height ft nip on time Pump off time Daily flow set at ••d _caN B 2'A1B Mason County OSS Installation Report pg. 2 Parcel# 22018- 5 I- BOO(ai ABANDONMENT RECORD Were existing septic components abandoned as part of this project? YES NO If yes, please describe'. NO Were all components pumped out and properly abandoned per WAC245-2?2A-0300? ❑ YES RECORD DRAWING d future development Typical a c Tn - permanentn eId and must be accurate and descriptivepenough to N N needf nance activities . . waterlines, D. e r,9 and proposeda ,. Drawingsbserva orrts. ear 8.ns,an e atton rantenane a access oints Incomplete e .hc finalns; llalon app. al and related pe. s. cells,]Oservdaon ports,tleenocz,and other msn;enanm am5z points Inmmalele Record�.awngs may tea.°atlC o a.delays 14 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. lo _oS /z3 1. Signature of Install° Date !� - & ' ", Printed Name of Signee o 7aae ? itet, MASON COUNTY PUBLIC HEALTH ,'`. NA; The undersigned approves this Installation Report and �t 'r 36a CC`` �} ' PAULA JOY JOHNSON Record Drawing on behalf of Mason County Public rY.'pCENEd 'CX l'ONEq Health: a` S R EXPU Sheri r-r-e/ tsyn ( o (n 123 lQ-ro_Zb 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 eeaeva.rzrz> a "TY \z„...4) 1 � il 2 8,X56 I u I a qq �$ i o<ze �'1 ' d 11 I DELK V.°e°SPA' tee ,,: i =7.0 c1e ll so 40 as GuLT 0 Z. v Grz u-p 1J w LIZ Alp n o ,i, O Y \ E C P 1 \Q s €Ye1-F-oh , (-CA96794 i 7 ITrI a c 2� o .\-3 p r:ve WaNt 1 � STFri ✓ At. 5 e (O U4:�. E45, \ � PAOLA:)T JOHNSON ..‘ ,y P i sst,� n sow( ��EXPIRES-Uri E_ Carte Pi. v�. I®_Oo - L9 Bev: 0 Cleanout 22 1,200 Gallon Septic Tank- EXI.Stirt 2-Compaztu_ent with Effluent Filter 3 D-Box with speed-levelers and cover to surface - 3 a APPROVED OCT 11 2023 MASON COUNTY ENVIROHYENTAL HEALTH RET