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Home My WebLink AboutSWG2023-00420 - SWG As-Built - 1/17/2024Imo; s.m. . Mason County OSS Installation Report pg. 1 JAN 1 'ISO COUNTY PUBLIC HEALTH APPLICANT/ PER IT INFORMATION RECtIVED Permit Number SWG 2023-0000420 Parce 027 Applicant Name DEBRA DEIR Subdivision (Name/Div/Block/Lot) Applicant Address 130 SE CRESCENT DR City. State. Zip SHELTON, WA. 98584 Installer Name BAMFORD SEPTIC REPAIR LLC Site Address SAME Designer Name CINDY WAITE INSTALLATION CHECKLIST I. Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type OSCAR COILS Pretreatment Type XO2 >5 ft. from foundation? - - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - - - ❑ ❑■ ❑ Z >50 ft. from surface water? - �r - -re r - ,r --.- - - ❑ ❑■ ❑ Cleanout between building and tank? - U 023 , - - ❑ 00 U Tank baffles present? - i JAN U 5 2 - - ❑ 0 ❑ d 24" access risers over each compartmen . - - ❑ ■❑ ❑ el W Effluent filter installed?- By4_- - - - - ■❑ ❑ ❑ cn Septic tank size 1200 gal Manufacturer EXISTING 0 D-box wat'r level and speed levelers used? - ❑ N/A ❑ YES ❑ NO ><O Manifold/D-box accessible from surface?- - ❑ ❑ ❑ t9 Check valves installed? - - ❑ ❑ ❑ OQ 2 Transport Line Size 1 Schedule/Class SCHEDULE 40 Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - N/A ❑■ YES ❑ NO 0 >100 ft. from wells? - -P-P- R V-E- ❑ ❑ _1 >100 ft. from surface water? - 00 W potable - -J� i- 7-202-4- - - ❑■ ❑ � >10 ft. from water lines?- - - - - Z > 5 ft. from property lines and easements ■❑ ❑ Q IMSO 9 COUNTY ENVIRONMENTAL.HEP i ft > 30 ft. from downgradient curtain/foundation drains? - J� - - - - ❑ 0 ❑ o Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - [] ❑ ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A 0 YES ❑ NO Pump tank size 1250 gal Manufacturer SOUND PLACEMENT 24' access riser(s)and accessible from surface?- - ❑ E ❑ d Alarm or Control Panel Installed? - - 0 ❑ ❑ 2 Control Panel equipped with Timer/ ETM / Counter- - 111 ❑ ❑ \\+ m n- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a_ Pump Make/Model XO2 KIT, INSTALLED PER XO2 SPEC: El Floats or ❑ Transducer d Tank draw down in/min Pump capacity gpm Squirt Height __, ft Pump on time Pump off time Daily flow set at gpd Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION ' Permit Number SWG.? ' 1«" Parcel ti j/T�f l S�5 e-clod Applicant Name .T. JS r. _ Subdivision (Name/Div/Block/Lot) Applicant Address City. State. Zip i c 5f; Ceesk eiJ 1' Installer Name /17Y)Ki21) Sri"?' Site Address JI?k lvri Itr,4• 95-51414 Uesi her Name 9 INSTALLATION CHECKLIST ❑ Full System Instaliatiyr ank(s)Only j Drainiield Only ❑Repair ❑Other System Type LL' u(.) -2.-- Pretreatment Type 06c-- 74c-,7... >5 ft. from foundation? ❑ NIA •YES ❑ NO >50 tt. from wells? - - ❑ ❑ • >50 ft. from surface water? - - - - - - z ❑ ❑ Q clew lout between building and tank? • ❑ ❑ U Tank baffles present? - - - - • ❑ 1 ❑ d24" access risers over each compartment?- - - - - • • . - ❑ , ❑ L Effluent filter installed?- -. - - K i fA ❑ ❑ Septic tank capacity (working) W IAJ 'gal ManufacturereN NW- '' CI D-box water level and speed levelers used? - ❑ N,A ❑ YES ❑ NO 0x0 ManifoldiD•box accessible from surface? - - - - • 1-_] ❑ CI m Z Check valves installed? - - - - - - - ❑ ❑ El 6Q .i I 2 Transport Line Size _-____ Scheduie:Class_-- Bedrooms installed (chock one) r) 2 3 ❑4 ❑ 5 ❑n ['Commercial/Other 2 a >10 ft. from foundation"? - - - - - ❑ NiA RYES ❑ No >100 ft. from wells? ❑ ❑ w >100 ft. from surface water? • - - - ❑ ❑ Er_ >1 0 ft. from potable water lines?- - - - .--ri-�- — -E - ❑ q ❑ Z > 5 ft. from property lines and ease � � ❑ ❑ a � 1 7 2024 lY > 30 ft. from downgradient curtain/1 a on d�'iTt`I.,') �1 ❑ Drainfield level and observation port@k20tJNTY ENVIRONMENTAL HEALTHI M ❑ ❑ Graveless chambers or 0 Clean gravel usr-JBWV:k ono) Proper cover installed over drainfield?• - - - - - - A ❑ ❑ Pump tank setbacks i;o•isi tent with se hc-taank? - - - - - - - - -- - - El NIA ❑ YES ❑ NO • Pump tank capacity (flood)__�`2r '1gal Manuracic.�er J P''S—_-- _ -- • 24" access riser(s)and accessible from surface?- - - - - - - - - - - - al ❑ ❑ H a. Alarm or Control Panel Installed? • - - - - - - ❑ ❑ \,� 2 Control Panel equipped with Timer 1 EMI ! Counter- -- - -- -• - -. - - - - E.] ❑ 71/\ / a- Pump installed in ❑ Bucket or 1Y Or Block or ❑ Other !_- . ___ . a �+O.I4 `l ''^ foals or Fran ducer 2 Pump Make/Model C%1.- . . _ _ . it, l a 1�4 f ❑ dTank draw down O __ Inimin Pump capacity_ _.5 _ gprri Squirt Height N . _-__it Pump on time_oak. _ Pump off lime e �_� Daily flow set at 4 0 _ gpd Ot 0.1:..,1 h,214Y173 sow 4 Mason County OSS Installation Report pg. 2 Parcel `t 3t`fit74' 5— cc125-7 ABANDONMENT RECORD Were existing septic components abandoned as part i,1 um.; project' - YES 0 NO If yes. please describe Were all components pumped r,t.:and properly abandoned per WAC246-272A-0300? - wriel �YES E] NO RECORD DRAWING + This is a permanent record and must be accurate and desr_nplrve enough to re-locate.n the need of maintenance activities and future development. Iyg.;;.ze rn.•c.a<I ,lLNn1:1.:r rt.;,$ r....r•.. i d e•1•••, .1 ,.., L,; 3'.,: .• ::..,I,_; i.., I.:Os I,• .,:v,' r.,ni ::r .. " ..... .q,_.I. .. I .,;i. . - ,. , I:..ic,:,din.of r,e.11s,v.:rt.idlnc:.. :.eil' .:•.•.r... i.: ...-... ', ...1r: .. ,... , . , r I , t riot t and P P it OV E ;••. JAN 17 2021+ 41ASON COUNTY ENVIRONMENTAL HEALTH JBW LA Record Drawing Attached CERTIFICATION OF INSTALLATION �1MYY. 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 nave been cleared/approved by both the designs', shown here have been cleared/approved by both and Mason County Public Health and meet all Stale myself and Mason County Public Health and rneet all and Mason County Codes. Slate and Mason County Codes i further certify that all information contained on this 1 further certify that all information contained on this form and attached Rec d Drawing is accurate. form and attached Record 0 awing is accurate. 'Z.1_7- 1)YZ- 7 of SlgnattirE rlstaifr„ 11 DatE' 0<4- S. I tta/Wirt) 1:$4' .1',,,s, A� .t•hyo ,, V Printed Nam<:el Su1re.: ---- i N,. ii•1 ---1 '� MASON COUNTY PUBLIC HEALTH z 51004 8 ' $, The undersigned approves this Installation Report and O CINDYE.WAGE () pp p LICENSED DESIGNER 1 Record Drawing on behalf of Mason County Public �w� � M iv. ib. �1, lAC Exr•IRES 05.10, t kl(- Sig,' n, o`L-.nv'ronr;leita!Health Specialist Date (stamp. signature and date) t i HIS I ORM MAY BE SCANNED AND All :.I• i .rat num.lc;VIEW c.N THE MASON COUN I Y WEB SI FL 'z'"""' ' Q cn v k I-K 1— w . f\ 5 �./ U z d . m 0 u z I- 0 0 z < 0w =I-L ,,, F O - � wu) z \i z0OaJ Z ' a Ci Q ZC� � Ocn0p _10 ? HCX IA \) h 1 wzwa < O - c0U � � zo - Qo - xWOw `al (.33 '" wx0N : JWQNQw = k V 1 \p Ur- QU22c� � x3• - C\i CV 0)46c0N. "'h tV s �y U � ,,, , s e . . ..: , . .. , .z. , .. - J ff ,-t` a' r Q ii G vIl; 1 C� A \ .�. n \ • •.. 1 ..7.1/ / Nt ,._.___ ,o . ' APPROVEflyi , . , irk JAN 1 7 2024 "oi 1 MASON COUNTY ENVIRONMENTAL HEALTii /i� ��— Tt -(--. ,____ ( rnsti 9 11 iv/ ..-„.4) § ift_os 1 \f‘\ APPROVE "V 5 1 1'1'Ai A8 . .0a Ca 1, !/ ` Y LICENSED DESIGNER I OCT 1 1 2023 R..o.o *" "e"':0, \�- tr=SON OU TYEUR ,MENTAL HEALTHti OSA ' it' 1 •. .... ... , . • • . - . . . 1 6--- coNots3c arisN33:7 "-"erf...1 .,-, .. - .....- •,,, , N.,, ,,:••• s ;„,,- - - •: • ../; .),..04., • ,-,F!, „-;•-,•-•,, . , , 6 r.,.....- ,...i• -1 f•ig N -q•'• *•''S:A- '''',•-.• sr------------1 - V------------ ss--........ 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