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HomeMy WebLinkAboutSWG2021-00250 - SWG As-Built Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SwG 2021-00250 Parcel# 32304-75-90090 Applicant Name Shawn Hake Subdivision (Name/Div/Block/Lot) Applicant Address 1005207th StSW City, State.. Zip Lynwood WA 98036 Installer Name Maples Excavating Site Address 211 N Hammer Ridge Dr, Lilliwaup Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Shallow Pressure Pretreatment Type >5ft. from foundation? --- ------ -- -- - - -- - --- - ---- - ❑ WA ®YES ❑ No >50 ft. from wells? - - - - -- - - - - - - - --- - - - - ❑ ❑ Y >50ft. from surface water? -- - - - -- --- -- -- - - - - - - - - - - ❑ ❑ Z H Cleanout between building and tank? --- --- - - - - - - - - - - - - - ❑ ® ❑ U Tank baffles present? -_ _ _ _ __ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . ❑ Q ❑ H 24"access risers over each compartment?---- - ❑ ® ❑ Q. UJ Effluent filter installed?- - - - - - - - -- - - - - - -- - - - - - - - - - - ❑ rn Septic tank capacity (working) 1.200 gal Manufacturer Hagerman of D-box water level and speed levelers used? - - - - - -- - - - - - - -- ❑ WA ❑ YES ® No OxO Manifold/D-box accessible from surface? - -- - - - - - - - ❑ ® ❑ m= Check valves installed? -- -- - - -- - - - - - -- - - ❑ ❑ oQ f Transport Line Site 2" Schedule/Clan 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑CommerciaVOther >10ft. from foundation?- ____ __ _ ___ _ _ _ ____ _ _ _ ____ . ❑ WA ® YEs NO O >100 ft. from wells?- - - - ------ ----- - - ------ --- - -- ❑ IN ❑ xj 1100 ft, from surface water? - - - - --- - - - ------- --- -- -- ❑ li 110 ft from potable water lines?-- --- - ----------- ---- - ❑ ❑ G > 5 ft, from property lines and easements?- - - -- --- - --____. ® ❑ O > 30 ft. from downgradient 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?- -- - --- - - - - - - ❑ WA ® YES ❑ NO Z Pump tank capacdy (Rood) 1,000 gal Manufacturer Hagerman Q 24-access nser(s)and accessible from surface?- - -- - - --- -_ _. ❑ ❑ aAlarm or Control Panel lnstalletl? - - - - - - - - - - - - - --- -- - - . ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter- - - - - - -- - - - Pump installed in ❑ Bucket or E On Block or ❑ Other d PumpMake/Mode1 AY McDonald 404011 EFA ® Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 28.5 opm Squirt Height 4 ft j Pump on time 3 min Pump off time 6 hr Daily flow set at 342 gpd uomi.e as.rza-e a i t r , Parcel# 32304- 7S- TO."? O Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD with, existing septic components abandoned as part of his protect? - -- -' - -' - -- "' ❑ YEs NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-03001 ------ - ' ❑ YES El NO RECORD DRAWING mu u a wnnmanr nemtl.M mua b-1—aa and 10aan0v..nuuan W Mouu:v N.n.ed or nn—Ranee&e Fa a and N m dv+NeFmne -'acd Ae nn o:awngsenniam DrMGed a nanddb on.nbdm n inn'S,,x WM u,x lnmvon.N In anay.'a—d,Ynnan eamns and Fndiand.,on,t. nrw.us.veleni"— Ls.eps.rvaYon pond.ae.nwq and cm..rnanniFaaa Kmm, Inwinoi N aam2.'.mdnoa Rat oda d ed..l deaysin ina radon. And---en--, Qoo T V' ® Record Draw ng Attached CERTIFICATION OF INSTALLATION [County NSTALLER DESIGNER/ENGINEER certify that I installed the system in eccordence with I certify that the system has been installed in accor. he septic design stamped"APPROVED"by Mason dance with the septic design stamped'APPROVED"by Public Health and that any deviations shown Mason County Public Health and that any deviations here have been claamolspprOVed by both the designer Shown here have been dearadlapproved by both and Mason County Public Health and meet all stale myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further per ify that all information contained on this 1 further certify that all information contained on this form and attached Record Drawing is accurate. farm and attached Record Drawing is accurate. �l.Cil�L' tli� 7"fy-2i Signature of Installer Date �I 6Qc�uL� Ivl-t.( L`� Printed Name of Signee .. F L ; ,? ?� MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and cf ,�In. ,�s Record Drawing on behaBof Ma son County Public PAULA AOv uoHNSON'. Health' �xnl BSc Signature OfErvironmenlal Health Speaelatt Date (Stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VvES SITE wov.a mnrm+e isual Alan' Cleanout © 1200 C,00r- Septic ank 2-Compartment wi Effluent Filter V 3 10o0 Gallon pump Ch ber 5 Valve Control Box w I13VLS It 33"LS, 00—� / 33"56"SeMi— COM a(+ MfP CWmvnc+y ell roa Prw / l 40 be f o wl �y 11 SL+foot SCMi d. fa c-t Sand. 3 X 90 ' �r�Yhufi APPROVED / DF 4Tevlchts @9 e. se� SEP 16 2024 Wfh res(r)P 'nbe+KWI MASON COUNTY ENVIRONMENTAL HEALTH M RFT �-56 211 yN a I65 11 ' onuLn JOY Jaegsaa'. $-Zb•QJ+ i