Loading...
HomeMy WebLinkAboutSWG2024-00007 - SWG As-Built - 3/10/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC EALTH APPLICANT/PERMIT INFORMATION Permit Number SwG 2024-00007 Parcel# 32033-41-50010 Applicant Name Kim Haglund Subdivision (Name/Div/Block/Lot) Applicant Address 261 BE Hamer Rd C j City, State, Zip Shelton,WA 98584 Installer Name Coun Line De to men Site Address 263 E Hamer Rd Shelton Designer Name Arrow Se is Desi ns Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? ----- - -- - - - - --- ------- ---- ❑ MIA YES NO >60ft.from wells? - -- - -- -- -- --- - - - --------- -- -- ❑ ® ❑ Z >50ft.from surface water? El--- -- ---=--- ------ - -- - -- ❑ ® FCleanout between building and tank? ------ ------------- ❑ ® ❑ U Tank baffles present? --- -- - - - -- ---------------- - ❑ ® ❑ S24"access risers over each compartment?---- -------- ---- ❑ ® ❑ W Effluent filter installed?----------- -- -- --- - - - --- --- ❑ ® ❑ 0) Septic tank capacity(working) 1 200 oat Manufacturer Miles Sand 8 Gravel 93 D-box water level and speed levelers used? -- ------------- ❑ NIA ❑ YES ® NO 0J 0 Manifold/D-box accessible from surface?---- - -- -- - ----- -- ❑ ® ❑ mg: Z Check valves installed? -- - - - - ------- -- - -- ❑ ® Elt]2 Transport Line Size 2- Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑3 ®4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?-- -- -- - ❑ NIA ■ YES ❑ NO >100 ft.from wells?-------- VhbiiD- -Wj ❑ ® ❑ >100 ft. from surface watr- - ❑ ® ❑Z >10 ft.from potable water linAR�Q ❑ ® ❑ 0 >5 ft.from property lines and ama�6qpp��poa!r1 is?-,v-� - --- -- ❑ ® ❑ >30 ft.from downgradient curtaiMou lgBNtlrtIIfWONMEirYRL HEnIiH ❑ ❑ Drainfield level and observation ports present Jaw- - - - -- - -- ❑ © ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- - - - -- - - - - - - - - - - - ❑ ® ❑ Pump tank setbaoks consistent with septic tank?-- ---- - --- --- ❑ NIA ® YES ❑ No 2 Pump tank capacity (flood) 1,200 pal Manufacturer Miles Sand 8 Gravel f24"access risede)and accessible from Surface?--- -- -- - - --_ - ❑ ❑ 11 Alarrn or Control Panel Installed? -- -- - - - - ---- ----- ---- ❑ ® ❑ 7 Control Panel equipped with TimerIETM/Counter-- - - ----- -- ❑ IN ❑ _a Pump installed in ❑ Bucket or ® On Block or ❑ Other a Pump MakelModel Zoeller N152 i Floats or ❑ Transducer Se a Tank draw down 1.75 in/min Pump capacity 38 gpm Squid Height 7.5 ft Pump on time 3 Minutes Pump oft time 6 Hours Daily flow set at 480 opd VFNttEY1140,8 Mason County OSS Installation Report pg. 2 Parwl# ABANDONMENT RECORD W. xla .g eepbc wmponema abard.rW as an of this pr jc,rV - - - - - - - - - - ----- ❑ YES NO If yes,please desQiba Were all components pumped out and properly abandared per WAC246272A-03W? ---"" El YES NO RECORD DRAWING me e a a.no.m rcm me moo a.mu.r r e.englw«wall ro m.wm In m.ire a m.Imm.w.mws..ee Mee.an.I.Fm.M. rpq, I axve v.wro.mem. name a ma�maa aNnwm Sawa smnuwrn see mua,,xom emw,memamrrou,eoavN ees PnG.e.e emal�y,Iwum awes,weal.., .w.m.a.m„�.ae..wn.use m..�ww�.e mnx.u. mmmwem acme owem mvwumuw+mnnn�a..w.ium a.mm �P � m Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certity that I installed the system in accordance with I certify that the system has been instattad in earor- 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 devtabons hem have been c/eared/appmved by boil the designer Shown here have been Cleared/approved by both arrd Mason County Public Health aw meet all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I fu a¢artily that M inforwat/on contained on this t Nnher certify Nat as information contained on this b d attached Remrd Dreyving is accurate. form and ahached Retort}Drawing is accurate. 2-Zo - ZS Signature of Installer Data MICHAEL LOVELY `. . Pdntad Name of Sign, O or l MASON COUNTY PUBLIC HEALTH The undarstgned approves this Installation Report and ,} Record Drawing on behalf of Mason County Public s I I s.a H eah PAULA XIV JOHNBON'�� a-to-Zs 5 nvaonmantw HewM 5paciwiat owe (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE U.a.asamaore , = 22Co i r lei M �FA�wND C-p/.51ej< t �'ARCGs��7-031-41 - 5DOto 2b3 SE CTAC2IER RD 504•EL-'Tanli WA 99584 i CS)3'x54' R;rne✓y i D.¢--fercYteslas' 9'a.t. - , • •,? bnAwech j l' ' mapppp �JOHN80N �—Ca - 2S OAudio-Vinp.3 Al n so © Cleanout �" — © 1200 Gallon Septic Tank 2-Compartment with A P P R O V E® N ox EN Went Filter (�^ O 1,200 Gallon PumP Chamber MAR 0 O5 Verve Control B MASON COUNTY ENVI ONMENMENTAL HEALTH J W ® av ■p COV. _ ��eSG°i .ilaRY.ffopv� 4 8K Pie... He.e 2-7 'x -7v Driv —4" w