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HomeMy WebLinkAboutSWG2023-00367 - SWG As-Built - 9/27/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH AP LICANTI PERMIT INFORMATION Permit Number SwG 2023-00* Parcel # 42126-24-00060 /� Applicant Name Scott&Christine Semanko Subdivision (Name/Div/Block/Lot) s�p �2/ Applicant Address 14651 N US Hwy 101 _//,Z�,r7� City, State, Zip Shelton wA 98584 Installer Name Me lea Excavtin CF/ Site Address 14714 N US Hwy 101 Designer Name Arrow Se tic Desi ns, Inc INSTALLATION CHECKLIST Q Full System Installation ❑Tank($)Only ❑ Drainfield Only ❑Repair ❑Other System Type Shallow Pressure Pretreatment Type >5ft, from foundation? -- - - - - -- - -- -- - - - -- - - - - - - ❑ NIA ®YES El No >soft. from wells? -- - - - - - - - - -- -- - - - - - - - - - - - - - - - ❑ © ❑ Z >50ft.from surface water? - - - - - - - - - - - - - - - - - - - - -- - - ❑ ❑ FCleanout between building and tank? ---- - - - - - - - - - - - - - - - ❑ ❑ U Tank baffles present? ---- - - - - - - ---- - - - - - - - - - - - - El ❑ 24" access risers over each compartment?- - - - - - - - - -- -- - - - ❑ ❑ Q. Effluent filter installed?- - - -- - - - - - - - - - - - - - - ❑ ❑ ❑ N Infiltrator Septic tank capacity (working) 1.500 at Manufacturer M 0-box water level and speed levelers used? - - - - - - - -- -- - -- - ❑ NIA ❑YES ® NO J 00 Manifold/D-box accessible from surface?-- ---- -- - - - - -- --- ❑ ® ❑ mZ Check valves installed? -- --& - - - - - - - ❑ ® ❑ o¢ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) [:] 2 ❑3 ❑4 ® 5 ❑6 ❑Commercial/Other >10ft. from foundation?-- - - - - - - - -- NIA ® YES NO >100 ft.from wells?- ----- -- - - - - - -1W!//i( � - - -- ❑ ❑ W R >100 ft. from surface wate -- - - -- -- - - - Elo ❑ M >10 ft. from potable water lines?-- -- --& 04- ❑ 0 El Z > 5 ft. from property lines and easements?- Y�c - -- - �- - El ❑ ❑ Q ❑ ❑ K > 30 ft.from downgradient curtain/foundation drains- - - - - - - - - Drainfield level and observation ports present - - - - - ``=-k-- - - ❑ ® ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over dnainfield?-- - - -- -- - - -- --- - --- ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - - - ---- ---- - ❑ NIA ® YES ❑ No ZPump tank capacity(flood) 1.500 at Manufacturer Infiltrator Q 24"access riser(s)and accessible from surface?- - -- - --- - - - -- ❑ W ❑ aAlarm or Control Panel Installed? - -- -- - - - - -- - - - -- - --- ❑ ® ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - - - - - - - - - - ❑ K ❑ 7 ii Pump installed in ❑ Bucket or ® On Block or ❑ Other a Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer f a Tank draw down 1.5 in/min Pump capacity 53 apm Squirt Height 5 ft Pump on time 2.8 min Pump off time 6 hr Daily flow set at 600 dptl ucw,w erz+rza+a Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD . ® were existing septic components abandoned as part of this projecCr -_______ _ _ __ ___ YES NO If Yea. please describe'. No Were all components pumped out and properly abandoned per WAC246-272A-0300? '------' ❑ YEe RECORD DRAWING _ TNb u a peimanant�awN one must ee.csunre one S u DOva aLnka IF law0p`+4NOM arrmv,rtsern a'ra 60,ez.g aria DmoueO euiklnSa,almEo of xels.vatMines. DrnMauvYein: D<aiaWBmenikl00nenbtlan 6layaR W W�aD fiwlwkllaKn aDD�oval anO mblN pannrta. vMs,Opaemtion pw.tlaencuY,aria mlia nulnunan�aaau points. Inwmpkte RernN DmJ.n9s meyw�a a080owI0Wys In SEE ATTRcz"ED Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I inst7system7MasOn I certify that the system has been installed in accor- the septic design dance with the septic design stamped"APPROVED'by County Public HeMason County Public Health and that any deviations here have been clamolapproveybog 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 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. r Slgnaturs of Installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH " The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: ` PAULA JOY JOHNSON i s ^ . .. Signature of Endmnmental Health Specialist Date (stamp,%gnaTure a of date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VleS SITE opaaNanrm'e 0 rp rav 40 �u q As_&At,* scot} cw seA�A4 -?,,&tfZz Z6-2.4-ow6,c OIX4 N u5 flow lul _ I5he�t� Otr RBS84 P�e?osed R„K;„' 40' X !vo (5)3 ' x tu I D. F. Pr. used is i 'r'.e use ® 1 C .G• W 7O1K60' _ v _ — _ _ _ — �@ Kew.- �VD '� He f r f � O Audio-Visual Alax'ai Cleanout 1500 Gallon Septic Tank 2-Compartment with Effluent Filter O1500 Gallon Pump Chamber APPROVED i O °al� Control BOX SEP 21 2024 MASON COUNTYENVIRONMENTALHEALTH REi 2$p 1 54D 149 PAULA JOY JONNMN'. L/L EW 1 8-26-L�