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HomeMy WebLinkAboutSWG2024-00221 - SWG As-Built - 4/23/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00221 Parcel # 42135-50-00045 Applicant Name Phillip& Donna Angelillo Subdivision (Name/Div/Block/Lot) Applicant Address 247 SE Weston Rd Clear Lake Tracts/Lot 21 City, State. Zip Shelton, WA 98584 Installer Name Schoening Excavating Site Address 740 W Clear Lake Dr, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST — ® Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair El Other System Type Sand-Lined Pressure eatment Type >5 ft. from foundation? S - - - ❑ N/A , YES ❑ NO >50 ft. from wells? - - El ElZ >50 ft. from surface water? -0 el-4 2�5 El 0 El Q Cleanout between building and tank? - - - - - ❑ El ❑ }- O Tank baffles present? - Ry ❑ ❑■ El 1-- 24" access risers over each compartmen 4'" - ❑ 0 El a W Effluent filter installed?- - ❑ U El N Septic tank capacity (working) 1,250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES Ei NO DO Manifold/D-box accessible from surface?- - El ■ mZ Check valves installed? g� 1 ❑ 0 ❑ 0< 40 E Transport Line Size 2" Schedule/Class Bedrooms installed (check one) ❑ 2 ® 3 ❑4 El 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES El NO O >100 ft. from wells?- - El • El W El 0 Cl>100 ft. from surface water? - - u. >10 ft. from potable water lines?- - ❑ 0 El Z > 5 ft. from property lines and easements?- - El El El El ® Elw > 30 ft. from downgradient curtain/foundation drains? - - O Drainfield level and observation ports present - - El II El El Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El El Pump tank setbacks consistent with septic tank? - - ❑ N/A I YES El NO • Pump tank capacity (flood) 1,000 qal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ ® ❑ ~ O. Alarm or Control Panel Installed? - - El © ❑ E Control Panel equipped with Timer/ETM /Counter- - El ® El n D- Pump installed in ❑ Bucket or 0 On Block or ❑ Other n'• Pump Make/Model Liberty F51 M ❑ Floats or © Transducer 0_ a Tank draw down 3 in/min Pump capacity 57 gprn Squirt Height 8 ft Pump on time 1.5 min Pump off time 6 hr Daily flow set at 360 qpd • Updated an i/2018 r , ., • . `f 2 i 3 5-so- oera+ - Mason County OSS Installation Report pg. 2 Parcel# 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? - - 0 YES 0 NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drair+.field,existing and proposed buildings,location of wells,waterlines, wells.observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. BUJ ��" A0.vvJ I Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER! ENGINEER I certify that 1 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 cleared/approved 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 I further certify that ail information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Sig ure of Installer C Date rid Brayden Schoening i''' ...,c Printed Name of Signee o •c •A ;+\ MASON COUNTY PUBLIC HEALTH .4' • r The undersigned approves this Installation Report ands i'` �� 1 ;� 51C0349 .• .) Record Drawing on behalf of Mason County Public +-rgVg, m PAULA JOY JOHNSON. \� Healb_m ps k'+rla'. In r 011 Li I h Specialist Date (stamp, signature and date) Signature of Environmental Heat ( p g THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY'NEB SITE updated 8,21/2018 • • Al.?' . A:r \. v..--,2- To?0C: .€5k -' , S ' L ---- r----rf% Al_ .\''':: 5°' Z.; S '73, yk¢cELa�i3-5'So'aQ° si t_oc2.l ,....t.,:,,.. 1 IAPPR • VED �PR3020 :AEON COUNTY EhV1RONMENT� HEALTH 1.1?-TaSET t-o-tink5 , x8�41 .: � c,o air Se , Al.:: 5t v2 —0-'50" 1MAA ,sand. C p —6' v2 KOttitt tti 0- a 3o o-�`� is 4 3(DA.�0s i araln �ea L a atr 52 S, 4t) °� ci well^ vZS2‘M Bed I �`�� ��%' ,$ QAudio-Visual A ` ? ' 3 ClearioL' e ti © 1200 Gallon Septic Tank 2-Compartment a°": �" ..,-re uent `i?ter 4 L�' `s Gallon Pip Chamber v� -r� '� O 1000 G2t1 �jL V" g r \ �.1 , 4v n.'"• 1f \ \ `�'P e. ,� • . \ - - il- \ �9 oi„,oe :, 1, SC , moo, v�-4 Lztzs ...c..--rAlgi AUA5JOUY1O9 HNSOV., t'1 S EXPIRES q.ZS-2S