Loading...
HomeMy WebLinkAboutSWG2023-00145 - SWG As-Built - 12/20/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00145 Parcel # 22018-50-00084 Applicant Name David Kircher Subdivision (Name/Div/Block/Lot) Applicant Address 51 E Pickering Dr Timberlake#1/ Lot 84 City, State, Zip Shelton, WA 98584 Installer Name Workman Contracting Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST II Full System Installation ❑Tank(s)Only E Drainfield Only 0 Repa:r ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - -. - 0 ❑ ❑ Z >50 ft. from surface water? - - 0 ❑ ❑ 1-- • Cleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - - ❑ 0 ❑ a24" access risers over each compartment?- - ❑ 0 ❑ u1 Effluent filter installed?- - ❑ 0 ❑ U) Septic tank capacity (working) 1,060 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO O Manifold/D-box accessible from su ace?- - ❑ 0 ❑ m— Check valves installed? - `�' ❑ 0 ❑ 0< 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 12 D 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO CI >100 ft. from wells?- - 0 ❑ ❑ W- >100 ft. from surface water' - - O ❑ ❑ ti >10 ft. from potable water lines? ❑ 0 ❑ Z Q- > 5 ft. from property lines and easements?- - - 1 43-a1 `�� - ❑ ❑ 0 ct > 30 ft. from downgradient curtain/foundation drains? ® ❑ ❑ o Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or iE Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- -- - - - - ❑ N/A 0 YES ❑ NO Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator Z < 24"access riser(s) and accessible from surface?- IC El o. Alarm or Control Panel Installed? - - 0 E Cl * Control Panel equipped with Timer;ETM/Counter- - ❑ E ❑ D n- Pump installed in Q Bucket or ❑ On Block or ❑ Other a PumpMake/Model Liberty280 � [1 Floats or El Transducer D • Tank draw down 2" in/min Pump capacity 50 gpm Squirt Height 9 ft Pump on time 1.2 min Pump off time 6 hr Daily flow set at 240 gpd Utbd:etl z.21120-a Parcel# 2 2 ol8 -so- 0°°.34- Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD ® YES 0 NO Were existing septic components�abandoned as part of this project? - � sue. If yes, please describe: 0 12C "\S O `" a] YES [] NO Were all components pumped out and properly abandoned per WAC246-272A-0300? 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 Draw,ngs contain: Drair-field E.manifold orientation&layout.SepoJpump tank lot on.North arrow,reserve drainfield,existing and proposed Suilc'ngs,locaton cf wells,watert,nes. wells,observation ports,deanouts,and other maintenance access Fonts. Incomplete Record Drawirgs may create acdrjonal delays in final Installation approval and related Dermas. - ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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 I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. \\THY,\, 1: �i - ---- t Z-t S-Z 3 Signature of Installer Date '.� r Printed Name of Signee c+o.• * ' � f. MASON COUNTY PUBLIC HEALTH �1 The undersigned approves this Installation Report and u' Record Drawing on behalf of Mason County Public i+o-c` l'AULA JOY JOHN oN •: 1I� ' L1'CI=f&t3Y1)Mi,Nt '' Health: � �i..s`S'(. .Der '`S-c\N 6 �Zo1 2� 12.- c `7 -Z-3 Signature of Environme tal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 821,20t8 AS- zu«T D4Olvct I Ong.,r Pwtird1 -2-2oMS- 50-000s4 51 E Pi o1,GGrin.o, Dv. S&AL ' 1uS30, _ t 1 1 t o Is 3 o k r 40 58.6.2 . . /7 if kr&E °7 // `��, • O Audio-Visual Alarm �` i`,h ei° © Cleanout • © 1000 Gallon Septic Tank 410o 2-Compartment with 95% . Effluent Filter Cr ^ k{Q�y O1000 Gallon Pump Chamber ( 0 O • O Valve Control Box '•4 1. • 7 ICl/ /‹.-------�`�kzo iNt Q "2 , ,, Co Z2 A" �� 3 1 v • r" v' •0✓r ''J( rj ieeve o Ct-`i v1E "t -t-v.i c� 10 G f 0..tn.4 '.el()+7C co"K..pa0 f L 2►n c-d 1...1-,ti-*-•e.g'c431 — a4 N o evt.CDU- t4—ck kerih - WR'Teiz- arl; •. Y - . � � .Qe rye '.?��IZ . � : ��,, APPROVED ``2 PAULA JOY 3JOHNSON\3\ DEC 2 O 2023 -it mi. EN" MASON COUNTY ENVIRONMENTAL HEALTH l2- (6r-Z3 RET