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Home My WebLink AboutSWG2023-00376 - SWG As-Built - 6/21/2024 .RECORD DRAWING (ASBUILT) pg. 7 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SwG 2023-00376 Assessor Parcel# 321275300213 Applicant Name Rock Holdings LLC Subdivision (Name/Div/Block/Lat) Applicant Address PO Box 66110 City, State, Zip Seattle, WA 98166 Installer Name No Worries Septic Services LLC Site Address 491 E Olde Lyme Rd Shelton Designer Name Adam Hunter-Jim Hunter&Associates INSTALLATION CHECKLIST Full System Installation ❑ Septic Tank Only ❑ Drainfreid Only ❑ Repair System Type Oscar Pretreatment Type x02 >5 ft.from foundation? -- --- -- --- - - -- -- - - -- - --- ❑NIA YES NO >50ft.from wells? -- - - - - - - -- - -- -- - - -- -- -- -- - - ❑ 9 ❑ Y >50 ft.from surface wateR -- --- - - - -- - -- - --- - --- -- - El10 ❑ Z El 10 ❑ Cleanout between building and tank? -- -- ---- --- - -- - - -- - O Tank baffles present? - - - - -- - -- - - - - - - - - - - - - - -- - -- ❑ R1 ❑ f 24"access risers over each compartment?- - - - -- ----- - - - -- ❑ ® ❑ IL ❑ El Effluent filter installed?-- - -- ----- -- --- - ----- -- - - - - y 1000 Hagerman Septic tank size Oal Manufacturer 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - NIA ❑YES ❑ NO 00 Manifold/D-box accessible from surface?--- - -- - -- - - - --- - - El Elf0= Check valves installed? - - - - -- - - -- - - - - - - - -- - - - - -- - ❑ ❑ 02 Transport Line Size 1" Schedule/Class 40 Bedrooms installed(check one) 692 ❑3 ❑4 ❑ 5 ❑6 >1oft.from foundation?-- - -- - - - - - - ---- -- - - - - --- -- ❑ NIA [aYES ❑ No 0 >100 ft. from wells?--- -- - -------- - --- -- - --- - --- - ❑ 9 ❑ W >100 ft.from surface wateR -- - - --- -- -- - - - ---- - - -- - ❑ ❑ LL >10ft. from potable water lines?- - -- ---- --- -- -- --- -- -- ❑ ® ❑ ZQ >5h.from m0pertylines and easements?-- - - - - - - - -- - - - - - ❑ ❑ LL' > 30 ft.from downgradient curtain/foundation drains?- -- - - - - - -- ❑ ❑ 0 Drainfield level and observation ports present - - - - - - - - - -- -- - ❑ Cl ❑ Graveless chambers or ❑ Clean gravel used? (check one) Oscar Proper cover installed over drainfield?-- - - - --- --- --- - -- -- ❑ ® ❑ Pump tank setbacks consistent with septic tank?----- - -- -- --- El NIA AYES ❑ NO Y Pump tank size 1000 Oal Manufacturer Hagerman 2 24"acoess risers)and accessible from surface?--- --- ------ - El � 9 a Ala"or Control Panel Installed? -- - -- -- - - - - - --- - -- - -- ❑ jControl Panel equipped with Timer/ETM /Counter- -- - - - - - - - - ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or [IOther X02 Pump MakelModel X02 W] Floats or ❑Transducer IL Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at opm m+ssa rmnoia ��aae� Mason County OSS Installation Report pg. 2 Parcel# 1> 2` O"-'4—^— ABANDONMENT RECORD ❑ . _ _____ ____ _ __ - VES Were existing septic Components abandoned as part of this project? NO If yes, please describe: 0 NO Were all components pumped out and properly abandons°per WAC246-272A-03007 --' -- - " RECORD DRAWING a outlaxga lamer na.nm,.ntmlm�, TN191e a pertneneM wcara ena moat Oe ewunb ena aeacXplNe eno,h b ml n In 1Xp neon of meliXenenco enllrXiea ena lulus aorebp ft TYPE aew k bulvn.NwNxmw.rexrve arelnfiAO.aWsrlydnl nCa N gevMgamMeln: Dminrretl8mmirnk oX.nle,'nnal.ywn.5al+tlrllrnnn urn IeeaaNp,eltltlaya Mflma mzmleuon epp�v+aleM rtleletl ew pemllls. we05.oMnlYdlipl purls.menauu,rA oIFaI melnlmenw ewaa polMe. Inwmpela RN err+M ma Ba Y oca Flush Valve Closed Gt Lit 3 G2 �A3 G3 LA0 ' .v^.wecn Flow Rate(gpm)Valve Closed GPM .Q ,a+es Flow Rate(gpm)Valve Open GPM '/L V Record Drawing Attachetl CERTIFICATION OF INSTALLATION DESIGNER/ENGINEER INSTALLER the System has been the system in accordance with I certify dance with theseptic design stamped installed 1 certify that I installed APPROVED"by the septic design stamped"APPROVED"by Mason shown Mason County Public Health and that any deviations County Public Health and that any deviations here have been cleam&appmved by both the designer myself and Man hem son County Public have been Healthand meet all and Mason County Public Health and meet all State State and Mason County Codes and Mason County Codes. I 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 Reccrd Drawing is accurate. to -) 7(77 Y Signature OfMatalle Date Panted Name of Signee -- - MASON COUNTY PUBLIC HEALTH i The undersigned approves this Installation Report and �{ Record Drawing on behalf Of Mason County Public seas i , !:. FN 2 Health: P14�o qn^ 1 L �2'( ( (stamp, sgnature end dale) Signature of Environments'Healh Speetalisf Dale uwalea erz rzote THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB 517E iit somrawmmmcs8 oomLLc DBA.AWArMCARACEs Pin Baer faSa CreMn,MA eM1LMr Axeed E � Pdcurrhv t Two Year Initial Service Policy for On Site Wastewater Treatment System Band Name: Model Number. Oscar %02 Instill Dare: Serial Number: 05.06.2024 N/A J INSTALL POLICY From the date of the installation,the installershall furnish this two-year service policy to the user.It is the responsibility of the system ownerto contact No Worries Septi ' rvi es LLf to setup inspections and/or service calls. 1. An Inspection/service call everytwelve months.Inspection includes adjustments and servicing of the mechanical and electrical components ensuring proper function. 2. An effluent quality inspection everytwelve months.Visually inspecting the color,turbidity and scum overflow and examination of odors. 3. Sampling from the aeration tank everytwelve months to determine if there are excess solids in the treatment plant.If the results determine a need for solids removal,the user will bear the responsibility of choosing the removal company and the costs incurred. 4. If any improper operation or improper installation is observed,that directly affects the performance of the units,which cannot be corrected at the time of inspection,the user will be notified immediately,in wrHing,of the conditions and estimated costs for the repair. Violations of the Policy include:Shutting off the electrical current to the system for more than 24 hours. Improper installation.Disconnecting the alarm system.Restricting ventilation W the aerator.Overloading the system beyond the rated capacity or designed usage.Introducing excessive amounts of harmful matter into the system Adjusvnents by anyone other than the service provider,to any components of the septic system that alter the performance.Any other forms of unusual abuse. THIS POLICY DOES NOT INCLUDE PUMPING SLUDGE FROM THE UNIT IF NECESSARY An annual renewable service policy affording the same coverage as the initial service is available Contact far mom pricing Information Nornitchm Aufbarity System Owner: Mason County Health Deparmnent Rock Holdmg[LLC Instal abon anon: Oisvibutor: 491 E 01&Lyme Rd Shelton,WA 985M Hagerman Installer: svnnre Company: No Worries Septic Services LLC Hagerman Technician: Customer William Smetana X For Office Use Only Agreement Wrinen: PC Sent Stamp Recorded N o nn T n O O 44_ o _ °s-c- iu 2q 4 1 m o r z _ -- /—�� o m m m o x v � m ~ n x 0 � —(Ol31dNIVtla O11d0E T3�JVNIVLO ItlNOStl]S � � � � � C N / a m y p _ m Y ♦�' 4 00 N A C S Z O A y O - n y D O x Z r I � ' n m FF� O a n n n m � Z m i n m 0