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HomeMy WebLinkAboutSWG2022-00535 - SWG As-Built - 4/22/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH ANTI PERMIT INFORMATION Permit Number SWG 2022-00535 Paroel# 32011-14-00050 Applicant Name Stephen Butterfield Subdivision (Name/Div/Block/Lot) R R111 Applicant Address 2230 E Agate Rd TR 5 OF SE NE S 9/115 S 52/116 F Cily, State, Zip Shelton WA 98564 Installer Name South Shore Construction Site Address same Designer Name AROW Septic Designs Inc INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type Attenuation Zone >5 ft.from foundation? ------- --- ---- - -- - ---- - - -- ❑ NIA ®YES ❑ NO >50ft.from wells? - --- -------- - - - - - - - - - - - - - -- - - ❑ ❑ Y >50ft,from surface water? --- -- - -- - -- - - - -- - - - -- - -- ❑ ❑ z ❑ FCleanout between building and tank? - -- - -- - - ----- - - -- ❑ U Tank baffles present? -- - - -- - --- - --- - --- - - --- -- - - ❑ El F 24"access risers over each compartment?--- - - --- -- --- - -- ❑ ❑ a Clu1 Effluent filter installed?-- --- ---------- -- - - - - --- - - ❑ Septic tank capacity(working) 1 --5 re Hagerman D D-box water level and speed levelers used? --------- -- -- -- ❑ NIA ❑ YES ® NO 0J 0 Manifold/D-box accessible from surface?--- --- -- ----- ❑ 092 Check valves installed? --- -a-k- _ ---- - ' ❑ ❑ o¢ 40 2 Transport Line Size 2 inch Schedule/Class Bedrooms installed(check one) ❑ 2 ❑3 K 4 ❑ 5 ❑6 ❑Commercial/Other >loft.from foundation?- _ _ _ _ _______ _ __ _ ____ _ _ _ _ _ - ❑ N/A ® Yes NO Q >100 ft.from wells?------------ ---- - --- - --- ----- ❑ K ❑ w >100 ft.from surface water?-- - - - --- ----- -- ---- --- - - ❑ ❑ u >loft.from potable water lines?- -- - -- - -- ------- - - - - -- ❑ ❑ z >5ft.from property lines and easements?-- -- - - - - ----- - - ❑ ❑� ❑ K > 30 ft.from downgradient curtaintfoundation drains?--- - - -- - -- ❑ ® ❑ 0 Dnainfield level and observation ports present - - -- - - ---- - - -- ❑ ❑ ❑ Graveless chambers or M Clean gravel used? (check one) Proper cover installed over drainfeld?--- - - --- - --- --- - - ❑ © ❑ Pump tank setbacks consistent with septic tank?-- - ---- -- - --- ❑ NIA ® YES ❑ NO Y Pump tank capacity (flood) 1,250 gal Manufacturer Hagerman z ?__ __ _ __ __ _ _ __ ❑ Q 24'access risers)and accessible from surface? ❑ IM ~ Alarm or Control Panel Installed? --- -- - -- - - - - - - - - ----- ❑ ® El0. ❑ 2 Control Panel equipped with Timer/ETM/Counter- - --- --- - - - Pump installed in ❑ Bucket or ® On Block or ❑ Other a Pump Make/Model Liberty 260 ® Floats or ❑ Transducer � Tank draw down 2 in/min Pump capacity 44 gpm Squid Height 3 ft a Pump on time 2.7 min Pump off time 6 hours Daily flow set at 400 gpd llptle�eE BR12J18 Mason County OSS Installation Report pg. 2 Pam -COOS _ ABANDONMENT RECORD Were existing septic mmponentsabantloned as part of this Prof '-- ---------- O No If yes,Please desonce: YE5 ❑ NO Were all o mponenls pumped out aM Drapery abandoned per WAC24627?A-0--- '------- RECORD DRAWING .+.1°�,.ea+.. paWy.mMW:Pan0e1E 6meNdCaMr:utm a'+N� ��^v met iaavn.w0 mw.rtxrw NeFM].��� Ti�aM NseEM� y�,..agemoan+,ae.wne.aa m..mrvarre�o� i�mv�a.ma x«�w Tyr G Record Drawing Attached CERTIFlCATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER i ceritry that I installed the system in acconiance with I certify that the system has been installed in act the septic design stamped APPROVED°by Mason dance with the septic design stamped'APPRO VED'by County Public Health and that any deviations shown Mason County Public Health and that any devtaborn here have been deared/approved by both the designer shown here have been dearediapproved by both and Mason County Public Health and meet all State mySoand Mason County Public Health and meet all and Mason County Codes State and Mason County Codes - I ruither certify that all information contained on this I further certify that all information contained on this / n atta fad Re 2wing is a 2te. tl rohn and attached Record wing is accurate. /sg ral5I'g�Z Signature of Installer Date c 4>, rya c� Meere .. . Pried Nana of ftma6 MASON COUNTY PUBLIC HEALTH 1c0349 ''S , The unde/sSiMd approves this rnsWlatiDn Report and `r_LPAULA JOV J fnN1:H �Onr_ Reconi Drawing on behalf of Mason County Public ses � Heal ' k-- B' - ature ofEmirdmantal Heal Specialist Date (stamp.signature antl date) THIS FORM MAY BE SCPNNEDAND AVAILABLE FOR pUBUC NEW ON THE MASON COUMYWFa aRE Uv°V«Bn�a 5CALC: 10b50'� 0s- ulll::� IOb 5nftie Aiilaa frld . 0w tdeamt•w-Od050 �. © Autlio-visl�l Alars i S e I�j} f�78SPN © Ckenout �G ,© 1200 Gallon Septic Tau' • 2-Compartmea[with mm eat Filter O4 lido Gallon Pump Chamber © valve Control Hax APR?11074 MA SON c oUNTyEIV oNMENT A AC HEA(TF 3`x 54' ?vmAl .BFWA Q��, Iwfit` rdServ� hiwn OAado-vvsuai Aaxz Cieeaout ©/ 1200 C-aUm Septic Tank 2-Compa,-tenatwsrs 9 Effl�tFn� b a G,von� Chamber © valve Caatsol3oa y6; Min J'0 df 100 1-loofa L H�� SVcdrIwattr4u f . 510J31e .�,. i 'Zy PAULA JOY JONNSON '. W ELL � Nt:ft.. axnPes