HomeMy WebLinkAboutSWG2021-00222 - SWG As-Built - 12/20/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021-00222 Parcel# 42209-51-00077
Applicant Name Fred 8 Elizabeth Campbell Subdivision (Name/Div/Block/Lot)
Applicant Address 1916 Walker Park Rd LAKE CUSHMAN#8 LOT:77
City, State, Zip Shelton,WA 98584 Installer Name Arrow Excavating
Site Address 481 N Fairway Dr W, Hoodsport Designer Name Arrow Septic Designs
INSTALLATION CHECKLIST
® Full System Installation 0 Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other
System Type Sand Lined Pressure Bed Pretreatment Type
>5 ft.from foundation? ❑ N/A I]YES ❑ NO
>50 ft from wells? - ❑ 0 0
2 >50 ft. from surface water? - - ❑ I ❑
t—
o Cleanout between building and tank? - ❑ ® ❑
Tank baffles present? - - ❑ IN ❑
d24" access risers over each compartment?- 0 ® 0
l Effluent filter installed?- I. ti
- 0 II 0
Septic tank capacity(working) aal Manufacturer Hagerman
O D-box water level and speed levelers used? ❑ N/A ❑YES 0 NO
Rd Manifold/D-box accessible from surface?- 0 0 MI
mZ Check valves installed? - Sal -Pr'-""-`p-±#,-LY' - - - ❑ It ❑
0<
f Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed(check one) 0 2 ❑� 3 ❑4 0 5 ❑ 5 0 Commercial/Other
>10 ft from foundation?- ❑ NIA ® YES 0 NO
O >100 ft. from wells? ❑ 0 0
W >100 ft. from surface water? - ❑ II
LT. >10 ft from potable water lines? ❑ ® 0
Q Z > 5 ft. from property lines and easements?- El ® ❑
ce > 30 ft. from tlowngratlient curtain/foundation drains? 0 0 0
Drainfield level and observation ports present - 0 0 ❑
❑ Graveless chambers or • Clean gravel used? (check one)
Proper cover installed over drainfield? ❑ a ❑
Pump tank setbacks consistent with septic tank?- ❑ N/A ® YES ❑ NO
Y Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman
N 24" 0 Elaccess riser(s) and accessible from surface? 0
4 Alarm or Control Panel Installed? - - 12 r 6�
h 'u 0 0
2 Control Panel equipped with Timer/ETM /Counter 0 0 0
0
1 Pump installed in ❑ Bucket or ® On Block or ❑ Other
O.• Pump Make/Model Liberty FL51 ❑ Floats or ® Transducer
1 m
Tank draw down 2 in/min Pumpcapacity 38 Height p y qpm Squirt Hei ht 7 ft
Pump on time 2.3 minutes Pump off time 6 hours Daily flow set at 360 gpd
Updated e,21a019
•
Parcel#42209~ S l — O00,
Mason County OSS Installation Report pg. 2
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project"?
Ej YES W NO
If yes, please describe.Were all components pumped out and properly abandored per WAC246-272A-0300o - ❑ YES NO
RECORD DRAWING
This permanent reco and must be accurated descriptiveenough re-locate the a of maintenance activities
and future development 'YMCA R c
J o o �n<asmena er sa t v tanki North a a.existing d p pavl 'g ,l tion of wells.waterlines
wells,m«gun+vont eenom:.and mth<.m . nne:ucessrom. r,A, J «Record o.+wns:maye.t<aao rm eny:"real nstallation approval and related permits..
hig
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 aceor-
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 andfttached Ree rd DrawinQ is accurate form and attached Record Drawing is accurate.
'G�/ ,ice12/zo/23 ".
Sgcr eture of Installer Date .-
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH L, *A'
/%7 s nor<s ' f±ti
The undersigned approves this Installation Report and S PAULA JOY :OHNSON : .1),
Pecos. - awing on behalf of Mason County Public LiCENSEDriESIGNER.
He "J/I APPROb
,Si ai nvirenmltalH pecialist Date JAN 11 144emp, ure and date)
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