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HomeMy WebLinkAboutSWG2021-00193 - SWG As-Built - 6/4/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00193 Parcel# 22233-32-90040 Applicant Name KS Homes LLC Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 1263 City, State, Zip Allyn, WA 98524 Installer Name South Shore Construction Site Address 4311 E Mason Lake Or W Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Shallow Pressure Pretreatment Type ,5 ft.from foundation? -- -- --- - ---- - - -- -- -- -- ----- ❑ NIA EYES E] NO >50 ft.from wells? - - - - - -- - - - - {2� ❑ E ❑ Z >50 ft.from surface water? -- --- -- -1L56- ❑ ® ❑ H Cleanout between building and tank? - !tByj 4 - ❑ E ❑ U Tank baffles present? .- - --- - -- - ❑ E ❑ a24"access risers over each compartme -- ❑ EW Effluent filter installed?-- --- ----- ❑ E ❑ N Septic tank capacity(working) 1250 oat Manufacturer Hagerman 0 D-box water level and speed levelers used? ------ ❑ NIA ❑ YES E NO QO Manifold/D-box accessible from surface?-- --------------- ❑ E ❑ d?Z Check valves installed? -- - ---- -- ❑ E ❑ t Transport Line Size 2- Schedule/Class 40 — Bedrooms installed (check one) ❑ 2 ❑3 E 4 [:] 5 ❑S ❑Commercial/Other >10ft.from foundation?- - ------ ------------- ---- ❑ NIA ® YES ❑ NO >100 ft.from wells?--- - ------------------------- ❑ ❑ W >100 ft. from surface water?---- - ------ ----------- -- ❑ ❑ LL >10 ft.from potable water lines? - - -- ---- -- ❑ ® ❑ Z > 5 ft.from property lines and easements? ❑ ® ❑ Q a > 30 ft.from tlowngratlient curtain/foundation drains?-- - ❑ ® ❑ DraiMeld level and observation ports present . - -- - - - ❑ ® ❑ E Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over dminfield?----- ---------- --- - Pump tank setbacks consistent with septic tank?------ ---- --- ❑ wA 0 YES ❑ NO Z Pump tank capacity (flood) 1250 gal Manufacturer Hagerman Q 24'access nser(s)and accessible from surface?-- -- - --- ----- E] 0 ❑ aAla"orControlPanelInstalled? - ------ --- ----------- ❑ 9 ❑ Control Panel equipped with Timer/ETM/Counter-- - - - ---- -- ❑ IF ❑ a Pump installed in ❑ Bucket or E On Block or ❑ Other a Pump Make/Model Liberty ISO E Floats or ❑ Transducer S a Tank draw down 2.25 in/min Pump capacity 50 gpm Squirt Height 5 ft Pump on time 2.4 Minutes Pump off time 6 Hours Daily flow set at 480 gpd upmrea erz�aoa Mason County OSS Installation Report pg. 2 Parcel# 222 25;--,�2 - 900'ly ABANDONMENT RECORD Were exmng septic components,abandoned as part of this pmject? -_-----_-----.- NO If yes, Please describe: Were all components pumped out and Properly abandoned per WAC246-272A-0300? -------- ❑ YES ❑ NO RECORD DRAWING rN,1.,o.,w,.d n.<.4 w mu.e o-,ar<m,oe e.unpaw awwn m.,,w.m aro n..a,r.Nm.nnu.amd.,and wu.d,..l,,,.,r• Twd�4 Pm.MO,WYW: @vID,10 d msNad alen,5m d Iryour Septiyum0 rank kutcn.NxT nex,mwwErtAB1.mwAnO N,raperM dJBYgt.ICf,>>n dwltwe�em, r,IN.N,naum N'e. .✓aq WsmNMba�e,Va%nh InamG4b RemE daxinW m,YC,le WNm,I CdgsNSW IMntlli.ypNN�IO Meed� V Record Drawing Attached .CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that/installed the system in aoccroance with I certify that the system has been installed in aowr- 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 clearedhappmved by both the designer shown here have been c/aaredrapproved 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 Codesl further certify that all information contained on this I further certify that all information contained on this ' aH ed Re rawing is a rate. form and attached Record Drawing is accurate. Signature oilnsfaller Date � �crh Mors2F ':1f Printed Name ofSignee t• "•" ,�A MASON COUNTY PUBLIC HEALTH . elom,y The undersignedapproves this Mste/lation Repa7 and PAULA JOV JO HNSON'. Record Drawing on behalf of Mason County Public 51 Nklt" Heattlh 6 Air)zV Signature ofFnvironmenial Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCPNNEDANDAVALMU FOR PUBLIC VIEWON THE MASON CWNN BSITE ume.av+vm+, I t .04 >p• (�5 BU,LT FuiwF 1p opose5l _._ KS HOMES FuTuP 3y Parcel 22233 32 40016 so e bOx90' 4311 � MnSOn LgK� Dr � SNoPwg s(OI �t� �"= b0� (i i 0 3e be Q6 f20 n f Ld� �TA 51CO3nB �� I PAOLA JOY JOHNSyN '. Zv yo i� tf5 Audio-Visual Alarm mo,AsE '' Cleanout 10 xmo 1200 Gallon Septic Tank 0' 2-00mpartment with ® E53uent Filter L% 12-00 C--on Pump Chamber -*7,kNK ONLY '^/itM Anti-Siphon, (JERMIT IF s va�,.e Con_r.<n1 Boz POAy ut,4ry ./ S,,oPE y IN5T-i LLEp © 1000ga1 2 com par+rru.n'+ EAS ENT � ' .iIN FtlTXAP-6 Sef+it 4"K Witt, I E�1=lutnt F{!'Ftr (2-) 3 x 40' PrivnanY dva,Prf iC NEleHeoa \ +rtno4le5 ® 5' OC, wrtln wEu- � I _ restrvG he�ow . b� APPROVED —JE M o soh I cxr-u Dr vd— JUN 04 2024 MASON COUNTY EN'4RONMENTAL HEALTh RET