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HomeMy WebLinkAboutSWG2020-00184 - SWG As-Built - 4/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY B ALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00184 Parcel# 42125-31-50010 RD Applicant Name Randy&Shannon Bruff Subdivision (Name/Div/Block/Lo RFCFryc Applicant Address 5281 W Skokomish Valley Rd LOT 1 OF LLS#06-03 PTN OF NE SW&NW S 2 City, State, Zip Shelton,WA 98584 Installer Name Rich Crump-Manke Ezcevating Site Address 5201 E Brockdale Rd,Shelton Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Sand-lined Pressure Bed Pretreatment Type >5ft. from foundation? --------------------------- ❑ wA .YES NO >50 ft.from wells? ------------ --------------- -- ❑ e ❑ Y >50ft.from surface water? ----- ------t-e �� - ❑ ❑ Z I C l'1 H Cleanout between building one tank? ------ =----- - ❑ ® El p Tank baffles present? -------------- IdQIt3Eg�- - ❑ 8 ❑ a 24"access risers over each compartment?------------- ❑ e ❑ W Effluent filter installed?------------------- ------- ❑ ® El _ Septic tank capacity(working) 1.250 gal Manufacturer Hagerman D-box water level and speed levelers used? --------------- ❑wA ❑YEs QNO OO Manifold/Dbox accessible from surface?----------------- ❑ ❑ oQ Check valves installed? -- ------- --- ❑ El 0 X Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ❑3 ®4 ❑ 5 ❑6 ❑Commercia0Other >10 ft.fromfoundation?-------------------- --- - -- ❑ NA . YEs ❑ No O >100 ft.from wells?-_ ----------------- ❑ e ❑ W >100 ft.from surface wateR------------------------ ❑ Z >10ft.from potable water lines?--------- ------------. ❑ ❑ Z >5 ft.from property Q p party lines and easements?---------------- ❑ ® ❑ S' >30 ft.from downgradient cur ain/foundation drains'---------- ❑ ® ❑ Drainfield level and observation ports present----- --------- ❑ ❑ ❑ Crevasse chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ ❑ Pump tank setbacks consistent with septic tank?------------- ❑ NA. ® YEs ❑ NO ZPump tank capacity(flood) 1.250 at Manufacturer Hagerman Q 24"access risers)and accessible from surface?-------------- ❑ ❑ aAlarm or control Panel installed? -----------y-0p~----- ❑ ® ❑ = Control Panel equipped with Timer/ETM/Counter- ❑ ® ❑ a Pump installed in ❑ Bucket or ® On Block or ❑ Other a Pump Make/Model Liberty 280 ® Floats or ❑Transducer a Tank draw down 2 in/min Pump capacity 46 gpre Squirt Height 2.5 ft Pump on time 2.6 minutes Pump off time 6 hours Daily Flow set at 480 gpd oee.aavz+�mie pCountyounty OSW;jj lation Report pg. 2Pa. =;- 421a0 ABANDONMENT RECORDslirg septic c abandonetl as part of this prolecr __ ________ C YES NOase tlescribaNOcomponents pand property abandoned per VdAC246272A-03007 ' -- - YEs `JRECORD DRAWINGma Mun ea+"i=P^en� Tycui R,u1m0OMt rOmN a1CUM Bne e!f[fip6V!lnOuall b K-IOGab In N!111M N m0lnbnanN aalvl0e! _tim OreNfie08mn 61arbY[SNtlt/GumG Mkb¢e•RereC prelinptmry0e01aa00i0mrn�l Cl1%0 maw OYi[dLYan IPNO hmuala anE Ma10e 0amiib.aeen P[ti.nwl[eaimme�w e[rev Pama. mmmolb Set A-4a0tvCe ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI ENGINEER i certify that 1 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 hers 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 Oil and Mason County Codes. State and Mason County Codes I further certify that all information contained on this f further certify that all information contained On this form andattached Record Drawing is accurate fomt and attached Record Drawing is accurate. Signatureoflnstellar U �te 7 Rr�,ard CjruY�p �r Printed Name of Slimes MASON COUNTY PUBLIC HEALTH mowls The undersigned approves this Installation Report antl PAULA JOY JOHNSON Record Drawing on behalf of Mason County Public �I:t-ONSE U f Health: °w� �( (3(z� -5- z1 -Zv Signature ntat Balm Specra6st Dare (stamp: signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON 7HE MASON COUNTY WEB SITE ummw arztrzo+e - -+rptiK b c G Y•a '� D SC', E S�— y Y Sam ! i k tWE�I- 0 �d #s U` e " �.yo Rc Hoene f in ik OAudio-Visual Alarm-SeeN � © Clesnout © 1200 Gallon Septic Tank \ \ 2-Compartment with APPROVEDEffluent Filter O 1100 G APR 0 3 2021 4 Gallon Pump Chamber \♦ MASON COUNTY ENVIRONMENTAL HEALTH RET 41 T L j 00 9 PAULA JO JOHNSON 'f:iCKll i I WIRF6 't A/ V Yl�