HomeMy WebLinkAboutSWG2023-00305 - SWG Application / As-Built - 1/29/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY P :LIC 6.. TH
APPLICANT/ PERMIT INFORMATION 24 ,y
Permit Number SWG 2023-00305 Parcel # 32234-51-00015 R� Z 9Z0"5.
Applicant Name Scott Barnard Subdivision (Name/Div/Block/Lot) CE� O
Applicant Address P.O. Box 417 OLYMPIC VISTA TR 15 &VAC OLYMPIC VISTA DR
City, State, Zip Shelton, WA 98584 Installer Name Joe Fassio Excavating
Site Address 401 E Olympic Vista Dr, Union Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type Shallow Pressure Pretreatment Type
>5 ft. from foundation? - - ❑ NIA ❑■ YES ❑ NO
>50 ft. from wells? - - El 0 ❑
• >50 ft. from surface water? - - ❑ I ❑
z ❑ 0 ❑
� Cleanout between building and tank? - -
U Tank baffles present? - - ❑ 0 ❑
F- 24' access risers over each compartment?- - - ❑ 0 ❑
W Effluent filter installed?- - El 0 El
N
Septic tank capacity (working) 1,060 gal Manufacturer Infiltrator
_0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO
XO Manifold/D-box accessible from surface?- - ❑ 0 ❑ -G �.
o u. Gl ffiu 4^-K - El ❑ .•
•
mZ Check valves installed? ❑ 1 '4
04 (2
2 Transport Line Size 2 inch Schedule/Class 40
i • i
CI
Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other N.'
>10 ft. from foundation? ❑ N/A ❑■ YES El �e
>100 ft. from wells?- ❑ 0 ❑
W >100 ft. from surface water? - -
u. >10 ft. from potable water lines? - -FEB -a 202 - ❑ 0 ElZ > 5 ft. from property lines and e is?- - ❑ 0 El
l & gi\ SJNLIENIAL kIE-ALTf- ❑ ME Cl� > 30 ft, from downgradient curta
• Drainfield level and observation ports present JBW - ❑ 0 ❑
® Graveless chambers or ❑ 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 su ce? -
❑ El CI
H
n. Alarm or Control Panel Installed? - - - �� '- -- - El0
2 Control Panel equipped with Timer/ ETM/Counter- - ❑ 0 ❑
n
n- Pump installed in 0 Bucket or ❑ On Block or ❑ Other
a. Pump Make/Model Zoeller N152 ❑■ Floats or ❑ Transducer
o_
a Tank draw down 1.25 in/min Pump capacity 30 gpm Squirt Height 9 ft
Pump on time 2 min Pump off time 6 hr Daily flow set at 240 gpd
;atad a,21 2C la
11i111.111111r
,
Parcel# 322-5000Ls
Mason County OSS Installation Report pg.
ABANDONMENT RECORD
- 0 Yes NO
Were existing septic components abandoned as part of this projecY? -
If yes, please describe: - ❑ YES ❑ NO
Were all components pumped out and properly abandoned per WAC246-272A-0300? -
RECORD DRAWING
ent T cal Record
This is a permanent record and must be accurate and descriptive enough to ra-locate in the need of maintenance activities and future developm YPr
Drawings contain: Dra rtfieid 8 manifold orientation&layout.SepsU tank location.NorM arrow,reserve dralnfield,existing and proposed buildings,location of wells,waterlines,
pumP welts,observation a Record Drawings may create additional delays in final installation approval and related permits.
ports.cteanouls,and other maintenance access ports. Incomplete
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FEB 2 0 2024
MASON COUNTY ENVIRONMENTAL HEALTH
J BW '5 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
/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.
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Sig re of installer ltte � T
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Printed Name of Signee
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MASON COUNTY PUBLIC HEALTH ,.' # ..
The undersigned approves this Installation Report and r1' ,a
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Re Drawing on behalf of Mason County Public j:� PAULA JOY JQHNSON
Health:' ( / L. ssb r.8i NE'ft
(/t,l `1 Q < 1 s-4Z'
Signatu vironmenta1 Health Specialist Date (stamp, signature--c..4 date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBUC VIEW ON THE MASON COUNTY WEB SITE UP1a/eC arz,aota
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Audio-Visual Alarm —
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3 Cleanout
E - 01\i P't P I G V 1ST 1\ 9 a" ` - O 1000 Gallon Septic Tank
2-Compar .ent with
N• ,t i JS s �u�� EMuent Filter
` "�\ ��� L 0' D'- 0,_��ipr ROV O 1000 Gallon.Pump Chamber
OValve Control Box
FEB Z 0 t�i� .
MASON COUNT' ENVIRONMENTAL HEALi i
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