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HomeMy WebLinkAboutSWG2024-00061 - SWG As-Built - 6/25/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00061 Parcel# 42002-00-62000 (partial) Applicant Name Sugar&Bean Coffee Company Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 189 City, State, Zip Shelton WA 98584 Installer Name Screening Excavating Site Address 19 W Sanderson Way, Shelton Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST ❑ FUII System Installation ®Tank(s)Only ❑ Dranfield Only ❑Repair ❑Other System Type Commercial Holtling Tank Pretreatment Type >5ft.from foundation? -- -- - --- - - -- - - ----- - -- - - - -. ❑ NIA ®YES NO >50 ft. from wells? - - - -- - - - - - - - --- - - - -- -- - -- - ---- ❑ ® ❑ Z >50ft.from surface water? -- - - - - - - --- -- -- -- - - - - -- El ® ❑ - H Cleanout between building and tank? - -- -- - - - -- --------- ❑ ® ❑ U Tank baffles present? - - - -- - - - - - - - - - - - - - ---- ----- ❑ ® ❑ a24" access risers over each compartment?-- - -- ----- - - ---- ❑ ® ❑ W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - ---- - - ❑ ❑ N Septic tank capacity(working) 1 250 gel Manufacturer Hagerman-single compadment • D-box water level and speed levelers used? - - - --- --- ❑ NIA ❑ YES ❑ NO DO Manifold/D-box accessible from surface? -- - - ----.��-\(�^- - ❑ ❑ ❑ mZ Check valves installed? - - - - -- - - -- - - - - - - - - - ❑ ❑ ❑ CQ g Transport Line Size 4' Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 M Commercial/Other >10 ft.fromfoundatlon?- - -- - - - --- - ---- ---- ---- - -- ❑ WA ❑ YES ❑ NO 0 >100 ft from wells?- -- - - -- - - -------- ------------ ❑ ❑ ❑ —I >100 ft. from surface water? - -- - - - - - ----- - - ---- ------ ❑ ❑ ❑ M 110ft. from potable water lines?- - - - - ---- - - ------ ( El I] ❑ > 5 ft. from property lines and easements?- -- - - - -- � - - - ❑ ❑ ❑ K > 30 ft,from tlowngradient curtain/foundation drains?-- - - -- -- -- ❑ ❑ ❑ Drainfield level and observation ports present - - - - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?-- - - - - -- -- -- -- --- -- ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?-- -- -- - - --- -- ❑ NIA ❑ YES ❑ NO Y Pump tank capacity (flood) gal Manufacturer aa"m>....:...t<) ...w......psi.r...,...,.r...o_ _ _ _ _ _ _ O ❑ ❑ a Alarm or Control Panel Installed? ----- - - ----- - ty ❑ ❑ ❑ Control Panel equipped with Timer y ETM/Counter-- - y— (�a->--- - Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump Make/Model ❑ Floats or ❑ Transducer 2 1 Tank draw down in/min Pump capacity opm Squirt Height ft Pump on time Pump off time Daily flow set at gpd uawrca ar.+rzoa Mason County OSS Installation Report pg. 2 Parcel# ` 2,0 Z— 00 ASANDONMENT RECORD ' - - - -- - " - " YES NO Were existing septic components abandoned as part of this project? - - - If yes, please describe: NO Were all components pumped out and properly abandoned per WAC246-272A-0300? ' - - - - " -- YES RECORD DRAWING Tb I.a wrm.n.nl nonN.oa mua,Ee,ecumt.ana encnFtiw.nweh u rt beau m N.need d mtlnuo.nn,mMwa.nd Mum cl.M.N .M. TvpIW Remo ommrps wm a onmmtle a manna Memetim a lavoui escrix mp ne Ipuuen.NOM pear,r.se,d ammrwld,among and p opmea ewimng..lOMW 1.1..we xN.n . wtl ,Mew on pane,d..—d,.pad nNer maenenenw ecmea WmN InwmplelaFeca'aDN-ns.n'ar Veme aaaa�wal eaters In nnam.allallon app,a'al na mlel.a pe�mlla. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with I 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 l further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. n/i~ (o Sig ,—of Installer Date Brayden Schoening Printed Name of Signee a+ r h MASON COUNTY PUBLIC HEALTH (a Y ._ The undersigned approves this Installation Report and ✓r3'� 51e "1 Record Drawing on behalf of Mason County Public PAULA JGY JOHN$pN '1'�� Healm: 315En Yl HIGNpN" I 11 -Zs- Signature ofiSmanortneritlil Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uWnee arzv:me / < | � TOT ± 6H SG Oro � \ © \ z - z { czLi � \ . \ � � < o _aSS3NIS m > | \ ƒ \ _ k } } \ 4,\ E , z !I - � ` § � k� m % / ` . { � 0 ^ � � A PROVED $ \ A & zzo ® \ \j MASON c, ET /