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HomeMy WebLinkAboutSWG2024-00190 - SWG As-Built - 8/9/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00190 Parcel # 32030-32-90011 Applicant Name Tracy Hanson Subdivision (Name/Div/Block/Lot) Applicant Address 120 Vista View Ct City.. State, Zip Shelton, WA 98584 Installer Name Joe Fassie Excavating Site Address 1410 W Cloq alum Rd Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST Q Full System Installation ❑Tan4(s)Only ❑ Oremtield Only ❑ Reps, ❑Oher System Type Shallow Pressure Pretreatment Type 15 ft.from foundation? - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA OYES NO 150 ft from wells? - - - - - - - - - - - Sri457 t(575� Il - ❑ ® ❑ Y >soR from surface water? - -- -- - -- - �- -- - �S-�J—Ir-"- ❑ ❑ Z - - -- - -- A ❑ ❑� ❑ Cleanout betweer, building and tank? - - - - - L) Tank baffles present? - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ a24 access risers over each compartment? ❑ W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - ' ❑ 0 ❑ U7 Septic tank capacity (working) 1,200 gal Manufacturer Hagerman ❑ D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ MIA ❑ YES NO �J 0O Manifold/D-box accessible from surface'- - - - - - - - - - - - - - - - - ❑ ® ❑ mZ Check valves installed? - - - - - - - - - - - - - - - —- - - - - - - - - El ❑Q 2 Transport line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 M 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- - - - - - - - - - - - - - - - - - - - - - - - ' ❑ NIA OYES ❑ NO 1100 ft. from wells?- - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ -� 1100 ft from surface water? - - - - - - - - - - - - - - - - - El El W u >1Dfi.from potable water lines?- - - - - - - - - - - - - - - - - - - - - - ❑ LEI ❑ Q > 5ft. from property lines and easements?- - - - - - - - - - - - - - - - ❑ ❑ X > 30ft-from downgradient curtain/foundation carts?---- - - -- -- ❑ ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑ © Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - ❑ 0 ❑ Pump tan'n setbacks consistent with septic tank?- - - - - - - - - - - - - ❑ NIA YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman 2 . ❑ ❑ Q 2a' access riser(5) and accessble from surtace q - - - - - - - - - - - . ~ Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - ' ❑ 0 ❑ a ❑ ❑ � Control Panel equipped with Timer/ETM /Counter- - - - - - - - - - - 7 o. Pump installed to M Bucket or ❑ On Bbck or ❑ Other a Pump Make/Model Zoeller N152 Floats or ❑ Transducer :D Tank draw down 2 in/min Pump capacity 38 gpm Squirt Heigh; 6 ft a Pump or time 2.3 min Pump off time 6 hr Daily flow set at 360 gpd Mason County OSS Installation Report pg. 2 Parcel# A,—,D NMENT RECORD art of his Prole' " '-- --- �- � - ---- YES No Were existing septic components abandoned as p If yes. Please describe: NO Were all components pumped out and property abandoned per WAC246-272A-03007 --'-'"" ❑ YES RECORD DRAWING mupennanan,�b and must M amn¢and aeacnpare.nwsn m Mooaa in M.rnM of malmmnmce aF nnn and NNn awNopmenc TniW RtteN oRlFiae a:reMOW:nmOtiY,alaYc'n.sNdUW.• Shkm..,NPP in——Gaina,,, oao,Ma MDmad WlklMz.l024M Ca ls.vldmfrN2z, o2+enGa CmVCP - WdCanN diW III aniiiii an adprn'al ene Hama 4a� v.Ws,a6ssryaan Gw6.pnnru¢,arc oRer—n: ns asess Win6. L maples Recwe Jzvnn9s maY aria 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 clearad/approved 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. mNZI Sig re of Installer Date J Joe FQ55 ' D e ' Panted Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behaH of Mason County Public Z' Ly PAULA OY JCHn60N S.j}b Health: JUCKNSC bl•SIGNEH ' cxe:ass 713i'/�o ' Signature of Environme tal Health Specialist Dare (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VrEB SITE r, 'Zk z� c APPROVED AUG 08 2024 U4 N Rt i (� 9 G• c,J iTK �� gaT'U �ffi N 200 Vic- Be='_:=k J�� laps vCC = -�—p =gib=_r Vwe Cont.! Box � u�a�er l:Ke —f-c be sleeved �i %V, ?Jn� N. : PAUTA JOY JOHNS ON �"+ 'r!cmis�rzn�s � �D wraes n.�& B -1- zsk