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HomeMy WebLinkAboutSWG2021-00609 - SWG As-Built - 6/13/2024 Mason County OSS InstallatioAPPLI MASON COU�Y PUBLIC HEALTH CANT] PERMIT INFORMATION Permit Number SWG 2021-00609 Parcel# 22029-34-50010 Subdivision (NamelDiv181ocklLot) Applicant Name Crai Parker Applicant Address 91 BE Kati Dr, Shelton Installer Name Bamford Se tic Re air City. State, Zip Shelton,P1A 98584 Designer Name Arrow Be tic East ns, Inc site Address I W SE Kalium Dr, Shelton INSTALLATION CHECKLIST ❑ptrer_�— ❑Tahl M Only ❑ Drainfald Only Repair it Full Systam Irstauation Shallow Pressure Pretreatment Type-- SYStem Type ❑ NIA Q YES NO >5 it from foundation? - - - - - - - - ��gg Tja �{{r - ❑ ❑ >50 ft.from wells? - - - - - - - - Ly OVj_LS�1_ 1p� ❑ ❑ Y >50 ft.from surface water? - - - - - - - _ p - ❑ 0 ❑ z -"JUN LI2QN UUU ❑ p Cleanout between building and tank? - ❑ ❑ U Tank baffles present? - - - - - - - - - ❑ ❑ ❑ F 24' access risers over each compartman By - - - W Effluent filter installed?- - - - - - " " " - Sound Placement rn y g 1.250 gal Manufacturer 0 No Septic tank capacit (working)y YES ? - - - - _ _ _ _ - -_ _ _ - NA O ❑ 0 D-box water lave' and speed levelers used ❑ ❑ RO ManifoldlD-box accessible from surface?- - - - - - _ _ _ ❑ [.Z Check valves installed. Schedule,Class__-_.__----- OQ 2 Transport Line Size 2 ❑ 3 O 4 ❑ 5 ❑6 ❑Commercial/Other ❑ YES ❑ NO Bedrooms installetl(check one) ❑ _ _ _ _ - NIA � ❑ >10 ft,from foundation?- - -- - " " " -- _ _ -_ _ - ❑ 1100 ft. from wells?- - - - - - - - - - - - - -- - - -_ - - - - - - - - - - - ❑ ❑ ❑ ❑ ❑ J >100 ft. from surface water? -- - - - - - - - - � Lu ❑ ❑ �- >10ft-from potable water lines?---- -- - - " _ - ❑ > 5 it from property lines and easements ❑ Q ❑ K > 30 k. from downgradlent curtain1foundation drains?-- -- -present __ _ ❑ Drainfield level and observatio °rtsn Clean gravel used? (check one) ❑ ❑ ❑ Graveless chambers or _ _ _ _ _ _ _ Proper cover installed over drainfield?- - - - - " - " ❑ NO Pump tank setbacks consistentwith septic tank?-------__ ❑ NA vas Manufacturer Sound Placement ❑ Y. ❑ ❑ PUMP tank capacity(flood) 1250 gal K - - --- ❑ Q24" access nsensl and 2CCeSSlble from SnrtaOe- - - -_ -- - ❑ ~ Alarm or Control Panel Installed? - - _ _ _ _ - ❑ d ed with Timer l ETM l Counter- ----- ? Control Panel equipped 0 On Block or ❑ Other C Pump'mstalled m ❑ Bucket or Q Floats or ❑ Transducer 13- Pump MakelM Zoeller N152odel 33 9Pm Squirt Height�ft 2 1.5 inlmin Pump capacity 480 gpd � Tank draw down Daily flow set at a off time 3 5 min Pump Pump on lime�� _ S o Z2oza - , I Parcel# Mason County OSS Installation ReABANDONMENT RECORD NO YES ® tic compocents abandonatl as pa^ of this prolanp -- Were existing sep _ YES NO If yes, please descibe ro erf abantloned Pe r WAC246-272A-0300? Were all components pumped cut and F p RECORD DRAWING diva d , p ,. .Ya l e mrd d : rx'ells. noes. an a t N nry a ev v n u at d d V oony ol,p ow. d r al�os,al PP ors, p ibis 1s a permanent rtmrtl d on 8 Y 'S p p G � q d m d I pran+n9smnla'. nla nfield8 . YIE tC . Inmmpee Rec Er'e^"n Yceam wen:,oe.evamo PPre.aeam...amd m,mer,ralm:emam�ar,.�es.P 0 Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNERt ENGINEER INSTALLER I certify that the system has been installed in scoot- PR INSTALLER certify that I installed the system m accordance with dance with the septic tic Heath end that any deviations by the septic design stariped'APPROVEf)by Mason Mason County roved by bath raved de bath the designer shown here have been clearetl/app County Public Health and that any deviations shown here have been cleared/app myself and Mason County Public Health and meet all and Masan County Public Health and meet all State State and Mason County Codes and Mason County Codes. I further certify that all information contained this form and aftaCho Record Drawing 1 further certify that alecoord Daatlong istaccurate this form and attache. J Gate Tom"Yf Signature of mstalle� Prated Name of 9gree r, } _ MASON COUNTY RL)gLIL HEALTH on Report and '-> eAULA for:UJDaB AONNeON`�� The undersigned approves this Installati ,O CICEHSEtiB) �IGNElt_c� � Record Drawing on behalf of Mason County Public [s � �I Aaes tr2 �. Health: �rs (stamp, signature and date) PEa,ed aa,ans Signatu o(Environmen;a Health Specialist Date THIS FORM MAY BE BOANNEO ANC AVAILABLE FOR PUBLIC VIEW ON THE MASON GCUNrY WEB SITE ua1UtA � 1 tt'N1a '� „ti d„ P R' o,. w �1n rLS�rJG �9 y OAudio-visual N� < Cleanout ^ I �J © ° 1200 Gallon en GTi ` o Effluent Filter O1200 Gallon Pump Chamber O Valve Control Box , APPROVED � v i UN 13 2024 MASO'I C;VN iT' pVIROFYWR L'HEALTH RET T W 6LL Scare V yo, o so Ha eo go x,. NI N 5 Pauli O JOHNSON J 0 1 SE Ka lC f ' cr 1tsnE�icr S..5S5_ u�ii_i `