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HomeMy WebLinkAboutSWG2021-00479 - SWG As-Built - 6/16/2024 Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SVVG 2021-0047q Parcel# 52013-50-90312 Applicant Name Josh &Jolene Martin Subdivision (Name/Div/Block/Lot) Applicant Address 881 W Delight Park Rd ESROM PLACE LOT: C OF SP#1130 City, State, Zip Shelton Wa 98584 Installer Name Jerry Upson Site Address 8965 W Shelton-MAtiock Rd Designer Name Micah Halverson INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑Repair ❑Other System Type Pressure-Trench's Pretreatment Type Attenuation Zone >5 ft.from foundation? - -- ------- --- - - -- -- -- -- ---- ❑NIA YES NO >50 ft.from wells? ---------------- -- -- -- -- - -- -.. ❑ ❑ Z >50ft.from surface water? - - - - - - --------- -- - - - - - -- ❑ ® ❑ F Cleanout between building and tank? -- -- ----- ---------- ❑ ® ❑ t,) Tank baffles present? - --- ------- - - - - - -- - - ------ ❑ ❑ 24"access risers over each compartment?- ---------- -- - - - ❑ ❑ a ❑ ■ ❑ W Effluent filter installed?- ----- -- -- -- - -- -- -- -- ----- - N Septic tank capacity(working) 1250 gal Manufacturer Hagerman M D-box water level and speed levelers used? -------- -- -- -- - 0N/A ❑ YES [I NO J 0OW Manifold/D-box accessible from surface?-- -- -- -- -- -- - -- - - ❑ ® ❑ eQZ Check valves installed? -- - - -- - - - - - - - - -- - --- - -- - ❑ e ❑ Transport Line Size 2 Schedule/Class sch40 Bedrooms installed (check one) ❑ 2 ❑3 N 4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?- - -- -------- - - - - - - - - - - - - -- ❑ NIA fires � NCEffO_ 0 >100 ft.from wells?- -- --- --------- -- -- - - - - - -- --- ❑ W >100 ft.from surface water!---------- -- -- -- -- -- -- - El r❑ M M >10ft,from potable water lines?-- ------- -- - - - - - ---- - - ❑ e i❑ b z >5ft.from property lines and easements?---- - - - - - - - - - - -- ❑ )❑ > 30 ft.from downgmdient curtain/foundation drains?- - - - - -- --- ❑ 0 ' Dreinfield level and observation ports present - --------- - - - ❑ � ® Greveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over dreinfield?-- -- - -- -- -- -- -- -- -- ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - -- - -- --- -- - ❑ N/A K res ❑ No `L Pump tank capacity(flood) 1455 gal Manufacturer Haqerman Q24"access riser(s)and accessible from surface?- - - - - -- -- -- -- ❑ ® Ela Alarm or Control Panel Installed? - --- -- -- -- -- - -- -- -- - - ❑ ❑ 2 Control Panel equipped with Timer/ETM/Counter- - - - - - ---- - ❑ ® ❑ M 0- Pump installed in ❑ Bucket or ❑ On Block or E Other Orenco PVU a Pump Make/Model Orenoo PF5005 ® Floats or ❑ Transducer a Tank draw down 2 in/min Pump rapacity 50 gpm Squirt Height 4.5 ft Pump on time 1 min Pump off time 3 Daily flow set at 400 opd u�veemnole Mason County OSS Installation Report pg. 2 Parcel a 52013-50-90312 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - -- ❑ YES [] NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - -- ❑ YES ❑ NO RECORD DRAWING This is a pxmanent recond and must the aau2le antl deactlptiva enough to re-bmb In Me dead Of malntalnnca aNvnlw and Mum Mvelapment Typwl Recto orowings wnmin: DminfNd a mended onenladm It IayuN,aspedWmp lank bwlion.NMM1 anaw,mserve dminflow milling and proposed bmi ings,oration olwells,waletlines. walls,observation amn,doorman, and mm,mab ¢eea in ,unds a skma. I doomphods Rewd Ddeam,a may uetle additional deaya in f I Iash,,om approval and related andate 0 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 clearedlapproved 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 all 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. 'I?egwe-� q1%j Z �l ! IF Signature of Installer Date 1. Jerry Upson ( Unavailable to sign) Printed Name of Signee y. ,g MASON COUNTY PUBLIC HEALTH 3: The undersigned approves this Installation Report and rr�� 511)(W011 Record Drawing on behalf of Mason County Public ff arA I-HAJUVNR � UCENseo ji :srAVER Health: .�. . 6 16/ar A EXPIaE3 08,•gr Signature of Envyxinmene7 Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upaaxe antYmtd Frain: mikkelsenseptidlc@gmad mr, Subject: [CAUTION:SUSPECT SENDER]OSS lnspedion request for Jolere Martin-SWG 202100179 Deb: 14May-2022 14:23 Atlaehmema: headmB22 [Savej [Open] Massaee M: 331r761d71192tl4c98306ad2lMgbd400000000010 B57328MBD3E59A94A39T684F85E180D803DE4 13480120DOFAF 822NB871D Caution: External Email Warning!This email has originated from outside of the Mason County Network. Do not click links or open attachments unless you recognize the sender, are expecting the email, and know the content is safe. If a link sends you to a website where you are asked to validate using your Account and Password, DO NOT DO SO! Instead, report the incident. Submittal request for: Jolene Martin Site Address: 8965 Shelton Matlock rd Permit Number: SWG 2021 00179 Parcel Number: 52013-50-90312 Requestors Name:Jerry T Upson Company Name: Mikkelsen Septic LLC Phone Number: 3604803571 Email Address: mikkelsensepticllc@gmail.com Inspection Request Date:2022-05-14 Inspection Type: Full System Comment\Notes: Thank you for submitting your final install request. The install should be complete and ready to inspect on the'Inspection Request Date'and remain uncovered for three business days to allow staff time to inspect. Poor weather situations may be accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backfll of system components. If no contact is made by the health department within the three business days of notice,the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. [|) [%3 » !p ! iE Rz| \K� ( 9 < =* k n !; m` ��� / m G 9, / M ; | !: ; !2 _ }a | ^ {k !O 00 ! \. � - - - - |§� x ■ i ' ®& | ` !! \ z ? » �w °tea Z ® w - Z Z - ® . . (n QL ~~ � - - - - - - � � � 117, k k « 0 2 R § & 1 , | k } \ m Lp §` § 2® § \ { % _ )\ ® � /{ § ( ! �| ® z � a m.H wemon Design C ' h & Jolene Martin Site Into: [SHEUN AT , m «om _ Rd. s, A a�oM & s ,es� ms& �©~m® 11 �� s,�oA2m_ong« nllcCcDoutlookam