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HomeMy WebLinkAboutSWG2023-00404 - SWG As-Built - 4/9/2024 rntAddreSS ty OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION ber SwG 2023-00404 Parcel# 42135-50-00042 ame Jeffrey&Jennifer Miles Subdivision (Name/Div/Slock/Lot) ddress 247 SE Weston Rd Clear Lake Tracts Lot: 22 Zip Shelton,WA 98584 Installer Name Bravden Schoeninc ss U>0 W Clear Lake Dr Designer Name Arrow Septic Desions INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other. System Type Sand Lined Pressure Bed Pretreatment Type >5ft.from foundation? - - ---- -- --- --- - ----- --- -- -- ❑NIA ® YES ❑ NO >50ft.from wells? -- - - - - - - - - - - --- - - - ----------- ❑ ❑ br Z >50ft.from surface water? -- -- - -- -- - - - - - - -- - ---- -- ❑ ❑ Q Cleanout between building and tank? - -- --- - -------- ---- ❑ 0 ❑ F U Tank baffles Present? -- - - -- - - -- ----- - -- - '-- - - --- ❑ � I— 24"access risers over each compartment?---- - ----- - - ---- ❑ ❑ WEffluent fitter installed?----------- ----- ------- - - ❑ ® El N Septic tank capacity(working) 1250 gal Manufacturer Hagerman O D-box water level and speed levelers used? - - -- -- ---- - -- -- ® NIA ❑ YES El NO OLL Manifold/D-box accessible from surface?-- - --- ----- ------ ❑ IN 1-11?z Check valves installed? -- - --- - -- - - -- - - - - ----- - - - ❑ ® El oQ 2" Schedule/Class 40 f Transport Line Size Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑CommerciallOther >loft.from foundation?--- ----------- --- --- - - - - - - ❑ NIA ® YES NO G >10oft.from wells?------------------------- -- - - ❑ ® ❑ W >too ft.from surface water?- - ------ ------- ---- - - --- ❑ 0 ❑ t% >loft.from potablewater lines?- -- ------- ---- - - - ---- - ❑ ❑ Z >5ft.from property lines and easements?---- --- -- ---- - -- El ❑ -I(0 > 30 ft.from downgradient curtainifoundation drains?- - - - - - -- -- El ❑ Drainfleld level and observation ports present - - ---- - - ---- -- ❑ ❑ Graveless chambers or M Clean gravel used? (check one) Proper cover installed over drainfield?--- - -- - --- -------- - ❑ ❑ FPUMPnk setbacks consistent with septic tank?-- ---- ---- - - ❑ NIA YES ❑ No nk capacity(flood) 1000 gal Manufacturer Hagerman ss nser(s)and accessible from surface?--------- --- ❑Control Panel Installed? --------- ----------- - ❑ ❑Panel equipped with Timer/ETM/Counter--- - -- --- - - ❑stalled in ❑ Bucket or e On Block or ❑ Other ake./Model Liberty 280 ❑Floats or Transducer 7) Tank draw down 2.5" intmin Pump capacity 47.5 apm Squirt Height 5 ft a Pump on time 1.9 Minutes Pump off time 6 Hours Daily flow set at 360 �I.,. Mason County OSS Installation Report pg. 2 Parcel# A2135-50-0004 2 ABANDONMENT RECORD YES ® NO Were existing septic components abandoned as part of this project? -- - - If yes, please describe -_ _ _ ___ - YES ❑ NO Were all components pumped out and property abandoned per WAC246-272A-0300 RECORD DRANNG pt a enough to �e-ons.in d,dada at mamumaw act need and firtun dnn d,s sd, rypial Recant mu is a wa^anant record one must w daunts one ae.cX boddi Ents.; prd,old 6 mmndd onian-a-a layout seporlwmp reek mats,NmM1 arrow. ave dramfiald.onatlng and pmpaadd doldo s.lo-auon N dials,xssddlana ayp.yossaum wds alias is yre oryiet natrosenm.poinln. Incomplete Rewtleramngsmayowls additional dNrysin final InaleOedm apProvel and relaW P°^rals_ SSE P TcAC ttED 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 a/I 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. 10-Z3- Sig ore of Installer Date Brayden Schoening Printed Name of Signee a 'is MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and stgoaav Record Drawing on behalf Of Mason County Public PAULA JOY JOHNSON'�.� Lii E UESfON Health: t ' 64 y�T1�vt� gm `�(q �_I IL- Zo-t3 Signature of Entaronniantal Health Specialist Date (stamp, signature and date) THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WER SITE �pdeea erztnote _W,Gl,�4�ZLit1=E �RJ -�G �ojg.3ti �nsEM£" SCALE: I"= 50' ��� E✓+SEME�� p 15 50 n5 ioo PLo7 ?LAN � �EFFRe�ENnl1FF3.Ml1.ES i Lob 5"?% 1P 2LUA I2r50-00042 r --i � Wo b�D W GI.Eft2l-AKE 'DIZIVE � J APPROVE / — APR 09 2024 Cb / MASON COUNTYENARONMENTALHEALTH G Q RET �1) 10,x 30, + Ci) 10 x 15.1 rr ,r Avy fres5ur8 bet! W94+, w i O'K30' +C0 70'X�� > r25Pa'" a brc! OAudio-Visual Alarm © Cleanout © 12oo Gallon Septic Tank 2-Compartment with Effluent Ellter O4 l000 Gallon Pump Chamber auan PAULA JOY JOMMSON 'L � .:tl11K Y Z-to .¢.3 137 �'OP ai SANK oZ ,