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HomeMy WebLinkAboutSWG2023-00061 - SWG As-Built - 11/20/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00061 Parcel# 22013-11-50240 Applicant Name Kevin 8 Jo Hansen-Holm Subdivision (Name/Div/Block/Lot) Applicant Address 360 E Walter Scott Dr TR 24 OF LLS AF#503508 S 14/90-92 City, State, Zip Shelton,WA 98584 Installer Name Weathertight Construction Site Address Same Designer Name Arrow Septic DesignifIrTs— INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑Repair ❑Other rU'I1 System Type Shallow Pressure Pretreatment Type F >5 ft. from foundation? -- - - - - - --- - ❑WA ®YES o >50 ft. from wells? - - - - - - - - - - -- - -- - - - - - - - - - - - - - - ❑ ❑ Z >50 ft. from surface water? ❑ ® ❑ F Cleanout between building and tank? - - ❑ ® ❑ U Tank baffles present? - -- - ----- - -- - -- -- - - - - - - - - -- ❑ ® ❑ o~. 24"access risers over each compartment?- - - - -- -- -- - -- --- ❑ ® ❑ w Effluent filter installed? - --- - - - - - - - ❑ ® El SepticSeptic tank capacity (working) 1200 gal Manufacturer Hagerman 13 D-box water level and speed levelers used? - - - - - -- ❑ WA ❑Yes © No DO Manifold/D-box accessible from surface?--- -- - - - -- - -- - - - - ❑ ® ❑ moQ Check valves installed? -- -- -- - --- - - -------- ---- - . ❑ ❑ f Transport Line Size 2- Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other 110 ft. from foundation?- - - - __ _____ _ ______ _ _____ _ - ❑ NIA YES NO >100 ft.from wells?- - -- -- -- - ---- ------------- --- ❑ 0 ❑ W >1DO ft. from surface water?-- - - -- -- - - -- --------- - - - ❑ ® ❑ a >10ft.from potable water lines?-------------- -------- ❑ ❑ > 5ft. from property lines and easements?- ---------- ---- . ❑ ❑ C >30 R from downgradient curtain/foundation drains?- -- -- -- - - - El ® ❑ 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 OYES NO Z Pump tank capacity(flood) 1000 at Manufacturer Haperman a 24-.p .daer(a)andscceealblefromsurfece7--------- - --- ❑ ❑ ~ a Alarm or Control Panel Installed? - - -------- - - - -------- ❑ ® 1-1 jControl Panel equipped with Timer/ETM/Counter- - -- - - - --- - ❑ ® ❑ _a Pump installed in ® Bucket or ❑ On Block or ❑ Other a Pump Make/Model Liberty LP280 £ P ® Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 37 ppm Squirt Height 2- ft Pump on time 2.3 min. Pump off time 6 hr. Daily flow set at 360 gl VIM M/A I! Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as Part of this ptolecYi -- --'- YES . No If yes, please describe: I] NO Ware all components pumped out and properiy abandoned per WAC246-272A-030V -- - ----- ❑ YE8 RECORD DRAWING flue enough u McuM In an.Paid,at melnnnanL[rttiNHe and Mum enxopment Typwl Rewra TLa b a I+nminenl n[ON and mutt b acGurtb and dn[n 9 Dmxin96 mMYn: oranaad a mdmun-Ylati 61ryou+.SepXJpWn9 Nnkb[aiP,M1 tMdi aPv^''+ddN`<,2MNtl.ouna l m,9+d99wdeullddi Nwfm and Panes wale.Wnruadon pain.dnnou6.an,PNn meintendnw mad 9dMai. InwnpMe Rare,D+aiwifgaimgwaiaY Wdi,wN deleya in Pryl ineWlaOon pWavel and MaM 9ePP115. 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 clearediapproved by both the designer shown hem 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 tardy that all information contained on this fond attached Record Qf6wmg is 6umte. farm and attached Record Drawing is accurate. 11 Signature of Install to Punted Name of Signee paid y' L MASON COUNTV PUBLIC HEA The uriderdigned approves this Inatalglun RepdiP no Record Drawingon behalf of Mason COVV fubh1 - as C PAULA acr JOHNSON`. Het/th: FN(e, ��01 � a t " a-, nweea Signature of Environmental Health 9p.ciahit Date 4 (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uaPun Nvm+e E WalicC Sco? Df ... Ive. , rIA s@ 0-L. w ,tom i i �r f 7iT,�, ( A�-ht11k Kevin + .o Holm-Haden' 1 1 ; SS Sispt parrr1#22013-I1-56140 r ,3ta0 E lA1n1 -[C Craft Dr . I Stals: i":50 I f o SS 5e 75 Po APPROVE NOV 2 0 2024 MASONCOUNTYEKWgONMENTALHEA H DJA 0 �7 7 sE'Y`,ye1 Audio-Visual Alarm `l c q Fy� © Cleaaoui © 1200 Gallon Septic Tank 2-Compartment with Emuent Filter ✓ 510 J�9 �' P�(ILA JOY JONN6pN', O 1000 02110m Rmlp Chwnber �1t OS Valve Control Bo L e r V-i PVT