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HomeMy WebLinkAboutSWG2023-00427 - SWG As-Built - 12/18/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PU EALTH APPLICANT/ PERMIT INFORMATION -` I Permit Number SWG 2023-00427 Parcel # 22133-76-90032 DEC 1 ,, Applicant Name Trina Gustafson Subdivision (Name/Div/Block/Lot) RECF/� D Applicant Address 20 E Snowcrest Ln City, State, Zip Shelton, WA 98584 Installer Name Workman Contracting, LLC Site Address 40 E Snowcrest Ln Designer Name Arrow Septic Designs, LLC INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only El Repair El Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - No ‘-kQ",'$e. - 0 N/A ❑ YES ❑ NO >50 ft. from wells? - - I El ❑ Z >50 ft.from surface water? - 1�pt�.s2 ,rr- - ❑ ❑ Q Cleanout between building and tank? - 'G - 4 ❑ ❑ t— U Tank baffles present? - - ❑ ❑ CI H 24" access risers over each compartment?- - ❑ 0 ❑ a W Effluent filter installed?- - ❑ U) Septic tank capacity (working) 1,200 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ■❑ N/A ❑ YES El NO gO ❑ ❑Manifold/D-box accessible from surface?- - mZ Check valves installed? - - ❑ ■❑ ❑ CIQ 40 2 Transport Line Size 2" Schedule/Class Bedrooms installed (check one) ❑ 2 El 3 l❑14 El 5 ❑6 El Commercial/Other >10 ft. from foundation?- - -tt D- 'Q`- `='``S1-' " - . N/A El YES ❑ NO 0 >100 ft. from wells?- - 0 ❑ ❑ W >100 ft. from surface water? - - ❑l CI u. >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 CI Q re > 30 ft.from downgradient curtain/foundation drains?- - ® El CI Drainfield level and observation ports present - - ❑ • ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A U] YES El NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ID © Ela Alarm or Control Panel Installed? - ��� - ❑ ❑ • 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ © ❑ m - Pump installed in ■❑ Bucket or ❑ On Block or El Other 2 Pump Make/Model Liberty 280 ❑■ Floats or ❑ Transducer a. a Tank draw down 1.5 in/min Pump capacity 28 gpm Squirt Height 10 ft Pump on time 3 min Pump off time 6 hr Daily flow set at 360 gpd ,,::Cates 9,2;:7J 1.1, Mason County OSS Installation Report pg. 2 Parcel# 1� \33-1(D" �003 ')-- ABANDONMENT RECORD _ YES NO Were existing septic components abandoned as part of this project? - - - -- - - - If yes, please describe: El YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - RECORD DRAWING Typical Record ve enough to re-locate in the need of maintenance activities and future development This n a permanent record ma must nebe accurate andu descriptive ed buid:ngs,location of wells,waterlines. Drawings conn: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow.reserve drainfield,exis^^•g and proposed wells,observation pores.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. S a A 77 I' Ci-t\t.'i) s Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNER/ENGINEER INSTALLER in accor- /certify that l installed the system in accordance with I certify that the system has been dance with the septic design tamped,APPROVED"by the septic design stamped"APPROVED"by Mason 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. 4 ,, _, Signature of Installer Date tAi\. . AlAi, Printed Name of Signee t'.4 ��i �'t\ MASON COUNTY PUBLIC HEALTH 04;31q 4. 42 ��� The undersigned approves this Installation Report and PAULA JOY3JOHNSON '. Drawing on behalf of Mason County Public ', Lj��gEOY JOHNS - Record D g1 ! ` Health: (stamp, signature and date) Signature of Environmental Health Specialist Date u�catec arz,,7o,a THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE — t. 4AVY'VJO L'irL. SCiAL.�o i"- 0. . (00' 1 Ph,Y° 4 2r0 40 Gov Fir; /y ! V- 1� ��,1NA :SU - SO /1,./ f's j 40 E c Ncwc.,�Es T 1-AN. y �$'SL,toe I f l /� 39, (3) 3 K pYver\o ,/ �` i /./. / P.-„res , 1/ i4 i / q} Q(i w 4 - • f 2'7i re,S,Vvt .tY‘. b(,i w•(4.n r ,, I :IL / / / i (,,, ,., 0 ojmule iVIVA 61 1 - / /// . • • r / M I I • "); A1)1. A„ ,:, 0 71 i I a t::*,,\ ..e Q Audio-Visual Alarm i, �W. 510;349 © Cleanout APPROVED LP ULA JOY JO NSON © 1200 Gallon Septic Tank DEC 18 2023 EXPIRES 2-Compartment with ( Z f$--7—.3 Effluent Filter MASON COUNTY ENVIRONMENTAL HEALTH 0 1000 Gallon Pump Chamber RET 0 Valve Control Box