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HomeMy WebLinkAboutSWG2024-00111 - SWG As-Built - 12/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00111 Parcel# 52009-75-90183 Applicant Name Kevin&Lesa Sills Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 850 PCL 2 OF BLA#96-63 PTN TR 15 S 13/91 S 54/34 City, State, Zip Lakebav WA 98349 Installer NameV61"I'Emn-tech SepSc 'E 'LL C. Site Address 300 W Reeves Hill Dr, Shelton Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST IR Full System Installalion ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? -- - -- - -- - -- ❑ NIA ®YES ❑ NO >50 ft.from wells? --- - --- - - - - ❑ it ❑ z >5o ft.from surface water? --- - - - --- - -- ❑ r Cleanout between building and tank? - -NOV ❑ o ❑ U Tank baffles present? - - ---- - -- - - -- - -- - - - --- ❑ ❑ Q. 24"access risers over each compartme Ily-- - - - - --- ❑ ® ❑ W Effluent fitter installed?------ --- - - - - - ---- ❑ ® ❑ W Septic tank capacity(working) 1 250 gal Manufacturer HB Precast 0 D-box water level and speed levelers used? -- ------------- [I WA ❑ YES 0NO 0J 0 Manifold/D-box accessible from surface7- --- -- -- - -- - - --- El ❑- mZ Check valves installed? - - - --- - - ------ - - - ------- - - ❑ ® ❑ 0Q 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- - ------------ - -------- -- El WA ® Yes NO 0 >100 ft.from wells?------------------ ---------- - ❑ 0 ❑ W d >100 ft.from surface water:+- - - ----- ----------- ---- - El0 El a >10 ft,from potable water lines?- - ---- --------- ------- ❑ ❑ > 5ft.from property lines and easements?--- -- --- -------- ❑ 0 ❑ X > 30 ft.from downgradient curtain/foundation drains?----- --- - - ❑ ® ❑ 0 Drainfield level and observation ports present ------ - - - ----- ❑ ® ❑ W Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- -- - -- ----------- -- ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- ---- ----- -- ❑ NIA ® YES ❑ No Y Pump tank capacity(flood) 1,200 gal Manufacturer HB Precast G24-access riser(s)and accessible from surface?----- ----- --- ❑ K ❑ ~ Ala"or Control Panel Installed? ----- - - - - - --- - - - - --- ❑ ® ❑ a Control Panel equipped with Timer/ETM/Counter-- - --- -- - - - ❑ ❑ 7 ll Pump installed in ❑ Bucket or ® On Block or ❑ Other o_ Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer a Tank draw down 2.5 in/min Pump capacity 55 gpm Squirt Height 3 ft Pump on time 1.6 min Pump off time 6 hr Daily bow set at 380gpd uvasea Wlwlr Mason County OSS Installation Report pg. 2 Parcel a 7 S ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - --- ❑ YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? -- --- --- ❑ YES ❑ NO RECORD DRAWING tab a a pamunam nwC and mum[ba amraw and aaacaptiva endueh m M° In the naad m maiMnana ac+ivalas and IUG2 aavewpnn R Typical n°Cwa Onn.1r,Conn: Dreia(mm a m.Md caimmtlpn a Id o,sepildpump tank lors.,War inow,naern dninfielQeaamgand propoaad aidrIl,I—W.panas waWl— welm,nh90Muon ppN,axmuLL,antl dhNmeime�anm aveu p Anm. Irc°mple+e Rac°N Dnwinpa mry vxm atla'2onal dNrye in final inmla4aEon Wpronl aM niamd Germile. ® 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 cleamd/appmved 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 I further certify that all information Contained on this l further certify that all information contained on this form and attached RecordDrawing is accurate. form and attached Record Drawing is accurate. Y �idieC✓$- �0-16�43F Signature oflnstaller II Date ULVTD G0YSNP6al Dr PnWed Name or Signee °d A MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and :+ . s+dd]ad N�iN(J Record Drawing on behalf of Masan County Public PAULA JOY JOHNSON ..L SE UE5( NEP(" Health: Q-ki�9/YV19�'Yl fill (�'�1 l(-zz-vf SignatureSignature of fillealth Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Wcaad'ad's 30' EASSME[JT �00 W4 Key: OAudio-Visual Afar= © cicanout 1200 Gallon Septic Tank p 6�0 © 2-Compartment with - Effiuent Filter O17.00 Gallon pump Chamber *iEHN� y1:�k�'.°�ve4c-�tpl^ovu UI�I1 OValve Control Box APPROVED f� DEC 1 1 2024 I MASON COUNTY ENVIRONMENTAL HEALTH I RET l06 K`.0.F. 33-7 3'x50' prCmn -tmaA es (& S` Q0. uA 140` be,�w I wettar'Id. �� Mc SPT-2A2-3 j Qat�