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HomeMy WebLinkAboutSWG2023-00425 - SWG As-Built - 1/16/2024 Mason County OSS Installation Report pg. 1 MA5Z7 1 I ON tY P BLIC HEALTH APPLICANT! PERMIT INFOR TIO,�ECEIVED Permit Number SWG 2023-00425 Parcel# 22029-75-00010 Applicant Name Katherine McBride Subdivision (Name/Div/Block/Lot) Applicant Address 1827 Lakehurst Dr SE TR A OF SURVEY 1/59 S 40/163 S 52/239 City, State, Zip Olympia,WA 98501 Installer Name Bamford Septic Repair Site Address 201 SE Lazy Dog Ln, Shelton Designer Name Arrow Septic Designs INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s) Only 0 Drainfield Only ❑ Repair ® Other System Type Pressure trench Pretreatment Type >5 ft.from foundation? - - ❑ N/A 0 YES ❑ No >50 ft. from wells? - - ❑ A 0 Y >50 ft. from surface water? - - 0 0 0 Z HCleanout between building and tank? - - ❑ 0 0 0 Tank baffles present? - - 0 0 0 H 24" access risers over each compartment?- - 0 0 0 O. W Effluent filter installed?- - ❑ 0 ❑ Cl) co I,oco t Septic tank capacity(working) (2) 1,200 gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO J p0 Manifold/D-box accessible from surface?- - 0 Al O?Z Check valves installed? - C - Fikraps.. - - - - - 0 ® 0 o a 40 2 Transport Line Size 2 inch Schedule/Class Bedrooms installed (check one) 0 2 0 3 0 4 ❑ 5 0 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO CI >100 ft. from wells?- - 0 0 0 W >100 ft. from surface water?- I © ❑E >10 ft. from potable water lines?- , -0 0 ❑ z > 5 ft. from property lines and easements?- - - - p- ❑ 0 0 a - 0?.k7 © ❑ te > 30 ft. from downgradient curtain/foundation dr - �•` � `i Drainfield level and observation ports present - 1RON(� AL-EAITH 0 0 ❑ Graveless chambers or 0 Clean gravel Me INieWbvey Proper cover installed over drainfield?- j13-114 0 ® ❑ Pump tank setbacks consistent with septic tank?- - ❑ NIA ® YES ❑ NO • Pump tank capacity (flood) 2,700 gal Manufacturer Sound Placement Z < 24" access riser(s) and accessible from surface?- - 0 0 ~ a Alarm or Control Panel Installed? - - 0 © CI E Control Panel equipped with Timer/ ETM /Counter- - 0 I 0 n- Pump installed in ❑ Bucket or [U On Block or ❑ Other d• Pump Make/Model Zoeller N-153 0 Floats or 0 Transducer a Tank draw down 2 in/min Pump capacity 90 gpm Squirt Height 3 ft Pump on time 2 min Pump off time 6 hours Daily flow set at 720 gpd U pdatee S212G18 Mason County OSS Installation Report pg. 2 Parcel# 2 2 02 I-15- coo to ABANDONMENT RECORD Were existing septic components abandoned \a^s_part of this project? - - '� YES ❑ NO If yes, please describe: CI)\a D. �• a tJ 6'11 e R } 1 CI � '`X o'` ot2�'M W'••S S t f9� Were all components pumped out and properly abandoned per WAC246-272A-0300? - YES ❑ 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. Dramfield&manifold orientation&layout.Septic/pump tank location.North arrow,reserve drainteld,existing and proposed builcings,location of wells,waterlines. wells,observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 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 certify that all information contained on this a •r -il information contained on this form and attached Record Drawing is accura p p Ir - -cord Drawing is accurate. L.L.=: - 12 /0C, 3 joi 16 2024 Signature of Installe J-__ N ., MASON COUN'Y ENVIRONMENTAL HEALTI t'' Printed Name of Signee `,B ?� :.f. MASON COUNTY PUBLIC HEALTH Y -,��rN The undersigned approves this Installation Report and A ! -- - 4•.1 tIt:C349 no 1, Record awing on behalf of Mason County Public � PAULA JOY JOHNSON •' �t l f/•4 ti itA2....4 -/��� EXPIRE 0�3�/�1 %Z.{' Signet re :nvilonmental Health Specialist Date (stamp, signature and date) I THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/21/2018 310' 4—° �.� .� �i �- .. i . fir-$-.) tle,c.o,n„. OWL - 15- Fjui _T 0L r O Zuti..75--ate(o / ` / . ,, 4 li _ C ` 1 . . \ .),_,T. ,.. t,,c4"•0•51'. (t i (1 " • grt T D i 1 . ' W a-VeA PP-5 VaJe yv007 1A^ Slee.recl r ^-%h S iiSz' i '0, Y 5 eio-t-t c ccN^eah.‘,..-er 2.51. o4Y" atd (Druper.-1, 1(wf, /, -7L \ - - -. Y (5) y.SD. �rvrary — — — R� R‘ P . ?R,075e 2 ! d roUY\ 6d t�/ S W GL L \ ' �u y\ 0 5' oc). W l"k4% - ` ' / / - go Yes,rve So �kn � rNrm. � Sc ..2. `ems 'N. c k E e *9.rJ . 07. 5to e n ' . . P �4 s ec3ae �� . .. PAULA JOY JOHNSON Maw, 1 1 1 1 r`a gq.iklS0)1), 119NR:--- y G 0.b v� 1. ' 5 "pcp REs ` vT -ems il i 1 1 t-If-"Dt _ �r Audio-Viso Alas— • '' 3 C f ear_ot<` R O E n 1200 Cron Septic Tank AIPIP ----12-Co mar en t with 2�2�1 Ef een_Filter 1 pA 1 6 0 2100 won Pump Chamber MASON COUNT ENVIRONMENTAL HEALTH JBW Q Vaty Control 13c7 OtItti;,�erSl�tL ja 2'GartpartIntl* . wi-Yh pv�rr��n Zr►a �E►arsi.cr • jl00o baJ[or Stfksc. Tay* Z-GO►. tnJC +Poxierrt c i sot-l1t vooc4 tA ?..•.1 C Nott:tr \t, ZZa