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HomeMy WebLinkAboutSWG2019-00512 - SWG As-Built - 12/18/2023 , �P trt , SG ,,,t �t 4/ ,, Mason County OSS Installation Report pg. 1 MASON COUNTY PUB IC F7 APPLICANT! PERMIT INFORMATION b ?3 Permit Number SWG 2019-00512 Parcel # 320301400150 �c��/v6*`, Applicant Name Andrew and Marcy Spear Subdivision (Name/Div/Block/Lot) Applicant Address 2000 W Shelton Valley Rd City, State, Zip Shelton,WA 98584 Installer Name Logan Spear Site Address 410 E Delanty Rd Designer Name Dale Tahia 1 INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Gravity Pretreatment Type _ >5 ft. from foundation? - - ❑ N/A ; YES El NO >50 ft. from wells? - El IN ❑ Z >50 ft. from surface water? - - CI Ili H ® CI ❑ Cleanout between building and tank? - - U Tank baffles present? - - ® ❑ ❑ n~. 24" access risers over each compartment?- - ❑ ® ❑ W Effluent filter installed?- ❑ II El l�> Septic tank size 1.200 gal Manufacturer Miles CI D-box water level and speed levelers used? - - ❑ N/A ® YES ❑ No oQJ Manifold/D-box accessible from surface?- - CIX El u. c9Z Check valves installed? - - ® ❑ El 0Q E Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ©6 ❑Commercial/Other >10 ft. from foundation?- - - - ❑ N/A ® YES ❑ NO CI >100 ft. from wells? >100 ft. from surface water? - W-> --cif-0 6 zap- El NI CIti. >10 ft. from potable water lines7.L-- - - ❑ ® El > 5 ft. from property lines and easemen� ?tr - ❑ NE El it >30 ft. from downgradient curtain/foundation - ❑ ® El ca Drainfield level and observation ports present - - ❑ ® Cl 4 Graveless chambers or El Clean gravel used? (check one) Proper cover installed over drainfield?- - El ® ❑ Pump tank setbacks consistant with septic tank?- - El N/A ❑ YES ❑ NO • Pump tank size gal Manufacturer < 24" access riser(s)and accessible from surface?- - ❑ ❑ ❑ HQ. Alarm or Control Panel Installed? - - ❑ El ❑ a Control Panel equipped with Timer/ ETM/Counter- - ❑ ❑ ❑ o- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a'• Pump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time_ Pump off time Daily flow set at gpd Updeled 8,21,2018 Mason County OSS Installation Report pg. 2 Parcel# 320301400150 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES © 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 8 manifold orientation&layout.Septic/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 peen ls. ® Record Drawing Attached CERTIFICATION OF INSTALLATION i INSTALLERDESIGNER/ENGINEER I certify that i installed the system in accordance with 1 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 I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. s.. .,r 41 L w` 6/05/2020 ` _I. Signature of Installer Dater �t Leej61.l_ 5 )-eu � ' j ,�� Printed Name of S gnee j ' iimh1.di 4 k' y F viAsiv"�,�i�. MASON COUNTY PUBLIC HEALTH `• t� S' r°I The undersigned approves this Installation Report and ,;or _• 5100214 .�, `1,, O Record Drawing on behalf of Mason County Public . O. DALE L. TA A +.+ Health: r► LICENSED DESIGNER t K2t7SL4A/r/A4f1 ( �lb I Z3 EXPIRES: -..W., . 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 8r21no18 00,-.) / df Y. (:,. . itkiD ‘VL., • 0 " --rli:r\ 9.,0 11011 rdO, .,1 - - r \(1',-4 V Oi APPROVED '` ' r /H . / 2023 ' - 0 0 j.P..,� i ;) DEC 18 / 3 MASON COUNTY ENVIRONMITAL HEALTH RET ! y 1 , ' i9 r • e i 0 tN, J,, , P 1 Fi: /f s :1‘ dliCy 1.H s z' st sr �11 In o r m,m N 4'o� � ', 0 o r . ` 0 0'-+ limy + • . .ip 1 i A'> ' - .."'"),,„4."1' , , e . , 4 xi' LI,54,,,,. or • , e . r• .- stk-rd. , ., \ ; g -/, , , „ ...4. ]) ,. ., \ \ ;r \ � •$�ear\ . Q' . .., _ , ,..? ' ..,, J ,l� \ - v t �,' Qrn �\\MP r hk