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HomeMy WebLinkAboutSWG2023-00471 - SWG As-Built - 12/1/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00471 Parcel # 31904-56-00009 Applicant Name Jack& Robin Williams Subdivision (Name/Div/Block/Lot) Applicant Address 2518 Lacrosse Ct Kadoun's/ Div 1/Lot 9 City, State, Zip Shelton, WA 98584 Installer Name Hanson Excavation, LLC Site Address 51 SE Holly Place, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - . - 0 ❑ ❑ Z >50 ft. from surface water? - - I El I-- Cleanout between building and tank? - - ❑ ❑■ El U Tank baffles present? - __ -__— - ❑ ❑� ❑ d .24" access risers over each compartment?- - ❑ 00 W Effluent filter installed?- - ❑ ❑■ ❑ u) Septic tank capacity (working) 1,000 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - ElN ❑ mZ Check valves installed? - °`} r"""'Q {e-s - ❑ 0 ❑ Da 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A Ei YES ❑ NO Cl >100 ft. from wells?- €- 7 r. I ❑ ❑ w >100 ft. from surface water? - - ❑■ ❑ ❑ L >10 ft.from potable water lines?- v ❑ 0 ❑ — > 5 ft. from property lines and easements?- - - - - NOV .J....?- g - - ❑ 0 ❑ a cc > 30 ft. from downgradient curtain/foundation dr�i ?- - 0 ❑ ❑ Drainfield level and observation ports present - . __-.._yT ❑ © ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - El ID ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A 0 YES ❑ NO • • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z < 24" access riser(s) and accessible from surface?- - ❑ I] ❑ ~ a Alarm or Control Panel Installed? - - ❑ II • Control Panel equipped with Timer/ETM /Counter- - ❑ It ❑ 0.. Pump installed in ❑ Bucket or ❑■ On Block or ❑ Other a• Pump Make/Model Liberty 280 ■❑ Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 29 gpm Squirt Height 8.5 ft Pump on time 2 min Pump off time 6 hr Daily flow set at 240 gpd 'Jpcat•^E.2'1?0'.9 Mason County OSS Installation Report pg. 2 Parcel# 3 H 0+- 5(- 6bc)0 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - in YES II NO If yes, please describe: ea_ � - --s \' 5' L ► Off. nR Were all components pumped out and properly abandoned per WAC246-272A-030C? - - 0 YES 0 NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout.Septic/pump tank location.North arrow,reserve drainfietd.existing and proposed bultdings,location of wells,waterlines, wells.observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approva and related permits. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER /certify that/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 toy both and Mason County Public Health and meet all State myself and Mason County Public Health aid 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. 7V�%frte--49)1,- 1 l-I'4--1,3 Sig ure of Installer Date .r.5 Jared Hanson , • 'feet Printed Name of Signee !e� '� r ��o• W. .rti% MASON COUNTY PUBLIC HEALTH ' :; The undersigned approves this Installation Report and �' �I * • - •r, Record Drawing on behalf of Mason County Public f�`�' JOY 9 .•0'. i-/c PAULA JOY JOHNSON ',� Health: 'l:1'CWaiU SiGNEtt": itii\-e4rtry V/71 i 2-4 11?;---S s-c *41:161 -E.S -gi'W--'-'......' 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 Uodated 8/2t2c18 (4)31 X15' P IPi Y �- F' �F l e o : vim Tvg,.u1�, — t�"� fAc--$O 1F a 1 �- 5 76 519 j OSbc-*-S.0-� ! 0 0� HE--7---------4 1 , ' ,ie \ \ , 1 _- z v O - - k \(31' \ . - - i \ • H- - - \ \ \ 7 :1 o \ . r � !i 1 I a 0 to T4 30 4G V� D?fl�ttiA A1" % c .L :3 1104-5 COo0471 Ac.kr.-- t R oB 11•i. \,tom 11--Li At-AS Key: 5 ! S E. P oL-L .j aarcE 0 Audio-Visual Alarm LTD 1.3 ) L`3A cf 8 Ez i- Cleanout 01000 Gallon Septic Tank APPROVED F f ump FA Pilter with DEC 01 2023 O 1000 Gallon Pump Chamber MASON COUNTY ENVIRONMENTAL HEALTh O Valve Control Box y �� RET t...4-.1 3.6‘t,i•j, 0 0 la +...._ .- tx.)0-,z• i=?''�' S'OC349 `'j Ye. "vIe,d 1 2` X 4-7 ' '0� PAULA JOY JOHVSON ' �� LtC�fSE ft—I 4°A' Z rtlo-� a ii� FYo pcSed hovYte 1 t 5 X Go' 1 ( -t-t -2,3