Loading...
HomeMy WebLinkAboutSWG As-Built - 2/2/2024 oo EnLLh7�f Mason County OSS Installation Report pg. 1 M,agOAl1017 C ��1yNTY UBLIC HEALTH APPLICANT/ PERMIT INFOR ATICRICEIVED Permit Number SWG 2021-00456 Parcel # 42204-50-00047 Applicant Name Keith Groom Subdivision (Name/Div/Block/Lot) Applicant Address 14626 SE 244th St LAKE CUSHMAN#5 TR 47 , S 47/204 City, State Zip Kent, WA 98042 Installer Name Maples Excavating Site Address 33 N Mt Washington PI, Hoodsport Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST $ Full System Installation ❑Tank(s) Only ❑ Di-airfield Only ❑ Repair ❑ Otee/ System Type Shallow Pressure Bed Pretreatment Type >5 ft. from foundation? - - ❑ NiA ❑� YES ❑ NO >50 ft from wells? - - i ❑� ❑ ❑ >50 ft. from surface water? - Z ❑� ❑ ❑ N• Cleanout between building and tank? - D 0 ❑ U Tank baffles present? - I CO23 ❑ 0 ❑ d24' access risers over each compartment'- t1}f ❑ Q ❑ LE Effluent filter installed' - ❑ • 0 ❑ W Septic tank size 1,000 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? 0 NIA ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- ❑ ❑ mZ Check valves installed? - - - - - - ❑ ] ❑ oa 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) E 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑CommerciallOther >10 ft.from foundation' - ❑ N/A ❑� YES ❑ NO O >100 ft. from wells'- - - • ❑ ❑ w >100 ft. from surface water? MI ❑ ❑ a >10 ft. from po:able water lines'- ❑ ❑ ❑ Z > 5 ft.from property lines and easements?- ❑ ❑� ❑ ix > 30 ft.from downgradient curtain/foundation drains" Pi ❑ ❑ o Diaintield level and observation ports present ❑ PI ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield' - ❑ Q ❑ Pump tank setbacks consistent with septic tank' . - -- ❑ NiA 0 YES ❑ NO • Pump tank size 1,000 gal Manufacturer Hagerman 2 < 24" access riser(s) and accessible from surface? ❑ • ❑ Alarm or Control Panel Installed? - - a. - ❑ U ❑ 2 Control Panel equipped with Timer; ETM /Counter- ❑ • ❑ 4. Pump installed in ❑ Bucket or . On Block or ❑ Other O.• Pump Make/Model Zoeller N152 ❑� Floats or ❑ Transducer eL a Tank draw down in/min Pump capacity gpm Squid Height ft Pump on time Pump off time 6 hr Daily flow set at 240 gpd QT.�v\^as to Ik?-f. 5-t*- v5A-LIZA2vi eti - r i 5 OnS'f S, bacN.1_.aItt Mason County OSS Installation Report pg. 2 Parcel# 422 C 4 - so - 0oc 41 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ❑ YES i;IN NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-03002 D YES 0 NO RECORD DRAWING This is a permanent rtcor and must be accurate and descriptive enough to Notate in the need of maintenance activities and future development Typical Record Dravnngs contain: Mat teia&manifold onenatim b layout.septicryvnp tank Boston.noM arrow.reserve dreirthad,meeting and proposed buildings, Wagon of wets,wa'ssnes. was,abservaion pone deanauts,ant other maintenance access points. Incomplete Record Drawings may create addi onal delays in final install/ton approval and mAated permits. ,. ft)/ _ Retard Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that l 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 1 further certify that all information contained on this 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawingr is accurate. Li�i�laller � ` \\/ZZ/z I O• Signature of Installer ( Date - � ` P4 Printed Name of Signee pe 'aa MASON COUNTY PUBLIC HEALTH s `i '41 The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public PAULA JOY JOHNSON ' 1 2. L(CSNS#0 DESIGNER" Health: / -^/ Ir ^7 <'m^s- �i ` Ili ',✓V l ° I (.7 irl EltPll¢a r"n Ts 1' Signature of Envim✓nmentAl Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE bMaPPRPlrzme �CC d 2� x Are_ O i c1� , ` / fir gip ; . -O ''c 0 OQ► / / S_ /! s ©l�� G to 3c AS .buiit _ / / KG1��, C7rootk 7 Par alccLk 2,04-50-000i-t / I ;3 Nth o'Arn WAsi4\NC,-CON C / // I o // APPROVED OCT 17 2023 kd50HCOU'iInPIv140h4ENTALHEALTH 3 w �i RET i h ij I Bev: 0 Audio-visual Alarm- -,�`--1,- E 3 Cleanout — ? V-4"41- . .T 3 1000 Gallon Septic Tank st..17 ^?ft1 2-Compartment with arim, im I-': 1•s 1000Effluent Filter f� 7 O4 1000 Gallon Pump Chamber AUL/, ( 0i . ' \ LICEUr)r.r GNSq" EXPIRE J/lY