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HomeMy WebLinkAboutSWG2022-00612 - SWG As-Built - 12/5/2023 a.. Mason County OSS Installation Report pg. 1 MASON COUNTY PU: IC HE • P . APPLICANT/ PERMIT INFORMATION UFr&. 0 6? Permit Number SWG 2022-00612 Parcel # 22017-75-00070 RFC 0?? Applicant Name Chris and Melody Auseth Subdivision (Name/Div/Block/Lot) FO Applicant Address 320 E Day Springs Rd City, State, Zip Shelton, Wa 98584 Installer Name Active Underground LLC Site Address Same as Above Designer Name James Medcalf INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pressure Pretreatment Type >5 ft.from foundation? - 1-I-TD-IFIT - ❑ N/A ®YES ❑ No >50 ft. from wells? - -Y �,• 1- �� ❑ ® ❑ ❑ • ❑ Y >50 ft. from surface water? + - z � () ��r-�5 rQ23 - -, - • Cleanout between building and tank? - --Li ❑ ® ❑ U Tank baffles present? - - ❑ Ill ❑ B P 24" access risers over each compartment'?-y------�--- -_--- ❑ ® ❑ a. W Effluent filter installed?- - ❑ It ❑ N Septic tank capacity(working) 1500 gal Manufacturer SPS 0 D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO J OO Manifold/D-box accessible from surface?- - ❑ 0 ❑ m 2 Check valves installed? - - ❑ ® ❑ 6Q 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 ® YES ❑ NO O >100 ft. from wells?- - ❑ In ❑ W >100 ft. from surface water? - - ❑ NI ❑ u. >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ • ❑ > 30 ft.from downgradient curtain/foundation drains? - - ❑ ® ❑ • Drainfield level and observation ports present - - ❑ II ❑ • Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A IN YES ❑ NO • Pump tank capacity(flood) 1585 gal Manufacturer SPS < 24" access riser(s)and accessible from surface?- - ❑ 0 ❑ aAlarm or Control Panel Installed? - - ❑ 40- El 0 El 2 Control Panel equipped with Timer/ETM /Counter- - ❑ • Ii ❑ v - Pump installed in ❑ Bucket or ❑ On Block or Q Other pump silo w/holes 18"off floor a• Pump Make/Model Liberty 290 PI Floats or ❑ Transducer a Tank draw down 2.5 in/min Pump capacity 68 gpm Squirt Height 5 ft Pump on time 1 Min 20 Sec Pump off time 6 Hour Daily flow set at 368 gpd Uod ted 8.21/2018 Mason County OSS Installation Report pg. 2 Parcel# 22017-75-00070 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES p■ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 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.Seplic/pump tank location,North arrow,reserve drainfield.existing and proposed buildings,location of wells,waterlines. wells,observation ports,cleanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. -fig-\_ \ \ (.."---1 (9,e....5 >2;e_ \.,-0e-S- „,..-.... [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 certf tbat- l formal twined on this I further certify that all information contained on this forrattac1l��f 1C'�c D g is accurate. form and attached Record Drawing is accurate. (----- ____.---;:---___ _ ----------- /Z. 4/Z- lia or 1 II I ign of Installer Date „5 r . + ure / v A ^� c,c' p i Printed Name of Signee ,i? �t, r , A.., CMASON COUNTY PUBLIC HEALTH c .The undersigned approves this Installation Report andRecord Drawing on behalf of Mason County Public ..vv.-....w�k� � „`�' Health: lir , 57 -x r 5/2 `6\M \-- <<t'123 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 updated 8/21/2018 // • y i Q 1-1 gz . mt%. . am00 11%` b ; , ~� a 2 rn ° w q 1%% • V 1 �j N Ln z M �%1 Sr.�.U! ° <1 lg (A w o �eti�. \ a c, o w - v� m 0 Q Ooo N. 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