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HomeMy WebLinkAboutSWG2023-00244 - SWG As-Built - 2/6/2024 ,(2(),,Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00244 Parcel # 12018-75-00010 Applicant Name Michael &Alec Sprouffske Subdivision (Name/Div/Block/Lot) Applicant Address 240 E Klondike Trail • City, State, Zip Shelton, WA 98584 Installer Name owner install Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type gravity trench Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - ❑ I ❑ • >50 ft. from surface water? Z - \ ❑ El ❑ < Cleanout between building and tank? - -I ❑ Iii I-- ;�� ❑ ❑ ❑ U Tank baffles present? p,=;y 4" - V a24" access risers over each compartment?- - ❑ 0 ❑ illEffluent filter installed?- .. ❑ ❑ N __-___ Septic tank capacity (working) 1250 gal Manufacturer Roth 0 D-box water level and speed levelers used? - - El N/A ® YES El NO J oO Manifold/D-box accessible from surface?- - ❑ II 0 o0Z Check valves installed? - - ❑ ❑ aQ 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑CommerciallOther >10 ft. from foundation?- - ❑ N/A YES ❑ NO 0 >100 ft. from wells?- - - - — — - - - LID ❑■ ❑ W >100 ft. from surface wate s',% R— — - -- ❑ El ❑ ii >10 ft. from potable water ;', �''Eyy�� - - - - �-� �-- - ❑ ❑ ❑ Z > 5 ft. from property lines . semen fs?- -- - - - ❑ El ❑ Q IX > 30 ft. from downgradieniul ia/ft iiiiikidNPcN14 A A-TH- - - - - ❑ © ❑ Drainfield level and observation ports prejeW ❑ A ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ ••. tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES MI NO • Pump tank ca.- (flood) gal Manufacturer Z < 24" access riser(s) and a - ible from surface? ■ ❑ ~ Alarm or Control Panel Installed? - - ❑ ❑ ❑ a 2 Control Panel equipped with Timer/ETM/Coun ❑ ❑ ❑ - - n a- Pump installed in ❑ Bucket or ■ •- i ock or ❑ • • 0- Pump Make/Model ❑ Flo- • or ❑ Transducer E 2. ft Tank draw in/min Pump capacity gpm Squirt Height a mp on time Pump off time Daily flow set at ,•• Updated 8f2112018 Mason County OSS Installation Report pg. 2 Parcel# 12018-75-00010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES ■ NO If yes, please describe: NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 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 ccntain: Drainfield&manifold orientation 8 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 end related permits. SE.. kR0VL,,,;;, FEB 2 .' 2 2024 MASON COUNTY ENVIRONMENTAL HEALTH JBw p 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 I further certify that all information contained on this form and att ed Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of stall Date 1� Alec Sprouffske . �. h Printed Name of Signee et.. of,�'�� MASON COUNTY PUBLIC HEALTH I #. . %, `P4. i L-IThe undersigned approves this Installation Report and `� .'�t. �.`Z' S'0.?a9 '�'�' Record Drawing on behalf of Mason County Public PAULA JOY JGHNSON .!"; Health: d -01?c.3fit is— Z 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&.2v_n18 1MIlli ,c..4%Sc,_' t " ::- CQ c I 4 / C T,, . (gyp 40 121) AS SU>>•--"C I\ r ! r CI OLip ��� ,2c 18-'I - (' ®CtIP it Q „�D (,�f* gbSe4 c� Km K . ,, �.,.,c , ��;; 0 Clear-out I M,.p O J f 7I. / O 1,200 Gallon Septic Tank / , 2-Compartment with Effluent Filter 1 . /I ( / / / n D-Box with speed-levelers (Qe Je ��-- r f 3l / �/ and cover to surface 5 4 ( A3 x 3 5Ysv,,tv,/ j01 c-c a'v'y \ t- F. 1.--y,-,,,c...cn es 9 ' bpi 0- C . l.l, -- . RCS ' .e14 ,e e '.i b.e tA32 -e h • P P R O V E 0.„,,- 1 . w., .. f '\,. FEB 2 2 2024 tri COUNTY ENVIRONMENT, ' 'LTri !! SN J BW S 1 or 4 06, ,,,, ,.. ..-.,,,,,/-,,, / .: .. .. lik-.:1-, am•• rA510C J49 • N05'i�PAULA4gYbfsHNoa.. \ -S-- t �vt l -33 1 .1,