Loading...
HomeMy WebLinkAboutSWG2024-00325 - SWG As-Built - 9/6/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PU IC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00325 Parcel# 52112-34-00000 0 Applicant Name William Reed Subdivision (Name/Div/Block/L ! RFCF SZ�� I Applicant Address 5051 W Skokomish Valley Rd O City, State, Zip Shelton WA 98584 Installer Name Ma lea Excavatin Site Address same Designer Name Arrow Be tic Desi ns Inc INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ®Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? -- --- --- ----- ---- - -- -- ----- NIA ®yes ❑ NO >50 ft.from wells? ------ - ------ - -_ ❑ ❑ Z >50 ft.from surface water? -- - -- - - - - " - "- -"- El ❑F Cleanout between building andtank? ---------- - ElO V Tank baffles present? -- - --- --- -- --- - --' --- - ❑ F 24"access risers over each compartment?- --------------- ❑ 0 ❑ C ❑ ® ❑ W Effluent filter installed?- -- - - -- - - - - - - - - - - - - - ' " -"--- W Fj(IstlRq COnCrete Septic tank capacity (working) 1 200 gal Manufacturer O D-box water level and speed levelers used? --------------- ❑ WA ❑ Yes No J ❑ 0 O Manifold/D-box accessible from surface?- - - - - - -- ❑ e?Z Check valves installed? - ---- - - - ---- - - --- - - - - "--"- El ® El O1 Transport Line Size 2- Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑3 „❑4 ❑ 5 ❑6 ❑CommemiallOther >10 ft.from foundation?-- -- - - - -- -- - ❑ NIA ® YES ❑ NO O >100 ft.from wells?- --- - --- - -- -- -- "yy�",-�- - ❑ ❑ W >100 ft.from surface water?-- - - - - - - -- - -$. - - lY ❑ ® ❑ a >10ft,from potable water lines?- - ---- y 0�7 - - ❑ ® El $__ _ _ _ ® ❑ Z > 5 ft.from property lines and easements?- -=�- -- - --G�- - ❑ Q W > 30 ft.from tlowngradient curtam/foundation drainsD+�1 - - -- - ❑ 0 ❑ O Drainfield level and observation ports present - - - - -- - - ----- ❑ ® ❑ ❑ Graveless chambers or K Clean gravel used? (check one) Proper cover installed over drainfield?------------ --- -- -- ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- - --- - --- --- ❑ WA ® Yes ❑ xo Y Pump tank capacity(flood) 1,060 oal Manufacturer Infiltrator Z ® ❑ Q 24' access nser(s)and accessible from sudecel-- - -- - - - - - - -- ❑ ❑ ~ Alan or Control Panel Installed? -- -- - - - - - - --- -- - -- -" - ❑ 0 a ❑ Control Panel equipped with Timer/ETM I Counter-- --- --- - - - ❑ 7 a Pump installed in ❑ Bucket or E On Block or ❑ Other a Pump Make/Model Zoeller N152 Floats or ❑ Transducer `t � Tank draw down 1.9 ''. in/min Pump capacity 47 apm Squirt Height ? ft 0 Pump on time 1.25 min Pump off time 6 hr Daily flow set at 240 xa aagp a Mason County OSS Installation Report pg. 2 Parcel# 52 1,2- 32t—00000 ABANDONMENT RECORD Were existlng septic components abandoned as part of this project? ---- - ---- -"-- - - ■ YEe NO if yes, please describe, m 0 NO Were all components pumped out and propedy abandoned per WAC240-272A-03007 ---- YES RECORD DRAWING ma is a wPwnane r.wrtl me moat w aaaNs antl e.a.d"'.an-,,u�aJwte in m.--ad w maimanan.a amines and�.Pervaaam.m. Trw 0 R.wm nm man mm.m: Dr iMwamenrcou on.wvanaarwrz.s.oliWu aunx lora4en.nwm anaw.reserre dranfiaa.msws.mcrnwa as.wrman "ad dwlnea, ,rgya.aCmrvamn Gon..tleanwaa.antl oM.rmaln�man2 a¢ess poims. IMa�eta Rwmd OnniN$maYa•a¢atltlNwul tlaayain finall insdONm eppmval and ranN w�mas. 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 cleared/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 1 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. -1, -14 /gnature of Installer Date S�2WW� Et1w�f�5 Printed Name of Signse MASON COUNTY PUBLIC HEALTHPi lip rh , The undersigned approves this Installation Repo AD ✓ F a<. Record Drawing on behalf of Mason Count�Publ/C /`• `t PAULA JOr JOHNSON '. Health: Nsoll CCU 16 20 a >< . I .I.. 7 Br6 d �A/ �C (- ouoyfNyinEl S 'Z7 -z4 Signature of Environmental Health Specialist �IYq I�fN'A f/ (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VvES SITE uc adamrzmn SeRLe•• l" =4 tl\LL4RM REED \ RHHFICEL 000Oa — 5051 W SyoKDMIS$ VAF RD SKOK°M` 8,kket-roK Wit 98584 SN (5)3 XZ'i PRIMAay P. F. -rgF-Icck•65 Gal q ` O •G. !`Si / /PO W�RESERVE BETvaEEN 40, EY,tSttNG 4.1 28/ 6 \ 63S�x m 'm7n J y�'� .�'5LEEJE WarF-R�rNE Gp to' OF All 5d' „;% WrrHtN WTI,- tP t.+.Ns ce MeN ENT 1F ENCUUNr%;FEG1 VXLL IV SNoP Q=TkSt Aot.E Rev: Q Audio-Visual Alarm *l: 0_z4`FIUE Loan+y sk�+d, o� P°$+ 24-S4�MEP. 5M'1D i GyFa6L © Cieanout a-z: 4o" F1N6 LPNNY 5AND 1200--Septic Tank 2-ComPartmeat--ad clC�t r i + C+P ,q Pp O4 1000 Gallon' Pump F Chamber r �f O V O Valve Control Box couNnfP �s?01y �t (ID Qbo pdFe s 03B 't urn r,o_, soN , DJA NMfNTq< B -2-1 -7A