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HomeMy WebLinkAboutSWG2024-00211 - SWG As-Built - 12/20/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2024-00211 Parcel# 32027-76-90017 Applicant Name John Lester Subdivision (Name/Div/Block/Lot) Applicant Address 625 W Railroad Ave#204 TR 1-C OF SURV 2/101 TR 3 OF SP#2766#632856 City, State, Zip Shelton WA 98584 Installer Name Workman Contracting Site Address 291 SE Harmony Ln Shelton Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ nrainfield Only ❑Repair ❑Other. System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? -- ------ -- ❑NrA AYES ❑ No >50 ft.from wells? -------- ---- OVE ❑ ❑ >50 ft.from surface water? ---- CY 1 4 Q Cleanout between building and tank? -- IRCE - - - ❑ ❑ NEl Q Tank baffles present? - - - ----- - - - -- - ' - - - ❑ a 24^access risers over each comps tmeY ❑ ❑ w Effluent fitter installed?-- --- --- --- - - - - - - - -------' ❑ ❑ N Hagerman Septic tank capacity(working) 1.250 gal Manufacturer O D-box water level and speed levelers used? ---- ----------- ❑ NIA ❑ YES NO �O Manifoltl/D-box accessible from surface?------------ - -- -- ❑ ® ❑ mZ Check valves installed? -- - - - - - --- - - -- ---- - - ---- - - ❑ ® ❑ 0 Q 40 2 Transport Line Size 2inch Schedule/Class Bedrooms installed (check one) ❑ 2 Q 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft,from foundation?-- -- - - ---- - ---- -------- - - - ❑ WA ® YES ❑ NO >100 ft, from wells?--------- ------------------- ❑ ❑ W >100 ft.from surface water?-------- ---------------- ❑ ® ❑ 1 >10ft.from potable water lines?- --- -- - ------- ----- - -- ❑ ® ❑ z > 5ft.from property lines and easements?-------------- - - ❑ ® ❑ Q K >30 ft.from downgretlient curtain/foundation drain?----- --- - - ❑ © ❑ 0 Dreinfield level and observation ports present --- --- - - - ----- ❑ ❑ Graveless chambers or W 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) 1,000 gal Manufacturer Hagerman Q24-access nser(e)and accessible from surface?-------- ----- ❑ ❑ ~ Alarm or Control Panel Installed? -- - - - -- - --- - - - -- - -- -- ❑ ❑ a 2 Control Panel equipped with Timer/ETM/Counter-- --- --- - - - ❑ � ❑ 7 rl Pump installed in E Bucket or ❑ On Block or ❑ Other a Pump Make/Model Zoeler N152 ® Floats or ❑ Transducer a Tank draw down 2" in/min Pump capacity 38 gpm Squirt Height 7 ft Pump on time 2.3 min Pump off time 6 hours Dairy flow set at 360 gpd �we�.a en,ao�a Mason County OSS Installation Report pg. 2 Parcel#3 2 ABANDONMENT RECORD p I NO Were exisrng septic components abandoned as part of this project'+ YES T" If yes, please describe: ❑ YES NO Were all components pumped out and property abandoned per WAC246-272A-0300? --""- "-- RECORD pRANANG .,Thu Ia a IMmanam mcpra am mun a smnm aw aspaW.e a�eusx ro rNepaN In aro u.ea of maliro.mnw acuawa am rue..a.wlapum�e Typial aemb p.e pmmam omx,nuaamne*mlenueunsmsbul.s.povwmpunk iemuon Nemate,m%aae aminrwa.evea�s a,a prupocaa emamee.motiondwals.vnmal�g5. weld,aecenaom pw¢.eeanam,em mnr ma�n+mauu av:c.pmma. lammolwe Rxnm orevnaga mey ov+e eaamoual dca»m nreI Iremisuen apwaal ana wrea cem,ie. 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 c/earedrapproved by both the designer shown here have been clearedlapproved 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 Dewing is accurate. s `I _ m - _ Jav"te Printed Name of Signee MASON COUNTY PUBLIC HEALTH � b The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public q, ,,PAUL5J^r uonrSON'yt Health: Y>E5t NER" + Signature of Envimnmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUN WEB BITE UMaua arzvmie s I w.g"bD i 1 0 Auyo-v;suat.57atni I © 1200,3*U=S*d.huk t I i I smamtfltxr 10 y r OA I 1000 G&U=Pump rh .^� I © valve Control HOX { 80 �'t99" 12 t i cA,pp i I I , I PC�Q OX. 70' l$}�.Hy N✓1 kWav G 3D' Rwnt�UT1LI'^I EhSFt'<ENT I 5911 I 3Zz ' APPROVED tro A";?,U I LT, DEC 2 0 2024 �pl}tJ LF_ STETL MASON COUNTY ENVIRONMENTAL HEALTH RET �lsr�cE>-� 32oZ"i-�6-�tacl� 2`L 1 SE t PtKKot4 L to 51� EI ry J WA 9 SSB fH` .' ste xae kAULAJOY JONN.SON', , I Z- 11- ?t