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HomeMy WebLinkAboutSWG2023-00281 - SWG As-Built - 9/11/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00281 Parcel# 22129-44-00020 Applicant Name Allan &Dan Kirk Subdivision (Name/Div/Block/Lot) Applicant Address 30 E Willchar Blvd SE SE SE SE SURVEY 35/66 City, State, Zip Shelton,WA 98584 Installer Name Mason County Excavating Site Address 1071 E Pickering Rd, Shelton Designer Name Arrow Septic Desgins INSTALLATION CHECKLIST alr Other �,ZOOgallonpre-trash tank ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Re p System Type Sha w Pressure Pretreatment Type ��i — ——- ❑ N/A El YES ❑ NO >5 ft.from foundation? - - �- � 0 >50 ft. from wells? - AUG? ❑ Y >50 ft. from surface water? 20-25- -- - - ❑ I ❑ Z - ❑ 0 ❑ HCleanout between building and tanay._ "-: • Tank baffles present? - _ -_i - -- - ❑ E ❑ F- 24" access risers over each compartment?- - ❑ ❑ d - ❑ El 0 N Effluent filter installed?- ;750 Septic tank capacity(working) NuWater BNR gal Manufacturer Hagerman ❑ D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑■ NO J XO Manifold/D-box accessible from surface?- - ❑ u. OOz Check valves installed? - - 0 0 ❑ ❑Q 2 Transport Line Size 2 inches Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ❑ 3 ❑4 ❑ 5 ®6 ii Commercial/Other >10 ft. from foundation?- - ❑ N/A Q YES ❑ NO ❑ >100 ft. from wells?- - ❑ ® ❑ J >100 ft. from surface water? W - ElX ❑ El u. >10 ft. from potable water lines?- - 0 Z > 5 ft. from property lines and easements? - ❑ I 0 ct > 30 ft.from downgradient curtain/foundation drains?- - ❑ © ❑ cl Drainfield level and observation ports present - - ❑ It ❑ 0 Graveless chambers or ig Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 II ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A Al YES ❑ NO Pump tank capacity(flood) (2)1,000 gal Manufacturer Hagerman Z ❑ H 24" access riser(s) and accessible from surface? ❑❑ © 0 a. Alarm or Control Panel Installed? III El Control Panel equipped with Timer/ ETM /Counter- - ❑ a Pump installed in ❑ Bucket or ® On Block or 0 Other d Pump Make/Model Liberty FL51M 0 Floats or El Transducer a E 2 ft Tank draw down 1.75 in/min Pump capacity 67 gpm Squirt Height Pump on time 2.8 minutes Pump off time 6 Daily flow set at 750 gpd Updated 8,21;2018 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD _ n YES Xl. NO Were existing septic components abandoned as part of this project? If yes, please describe: � YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING rmanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development Typical Record This is a pe P 8 Dravnngs contain: Drairt5eld&manifold orientation&layout.SepSc`pump tank locator.Nora arrow.reserve drz,n5eld,existing and proposed buildings,IOcaDOn of wells,vraterlines, wells,observation ports,cieanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. aE Pcv-v• ci- b liRecord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 all information contained on this form and atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. v2I1912C dr Aso of Installer mate �,•►'i, t 1 1 �c� • Printed Name of Signee (1/�t , Z��. 1 ` i - '.t � MASON COUNTY PUBLIC HEALTH } The undersigned approves this Installation Report and �`?' ro3ao i} PAULAJOYJOHNSON Record Drawing on behalf of Mason County Public LIGNa" t Health' 1 i I-1.A $-zs-2s Signature of Environment I Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2/2018 0 30 iio ao 1� t� 1 �BUIL� 4e I- • — PA C _ __ t.�r(a L.- '` '• 'rQ P.sad -) (ltio' ,,J.i.v r e Z -4�-000 °� ��°z 3c w%�-�C �' `gyp `i n<iq�t L f=12 NUR •e " � � PI - D I .rw- Ar- r � ®� t G te ge i •41 R4S040 SFP , 0 �, 5 0 .c- /i //// F/7 25 / /J/ Ii 0,446 (:(, / l ON1``Nlq` / / y,/1/4'41 dry I //// // ei A =-Te-s-4 _ i 1 // i - o� -I-.,Zg'' GS roc-5''0rr'0: ^-).._"'"34" vSL+r2C ko rn :z 0,-2 GSL,' 2"32' GS �I Wr! '"IG}�t�� �tl poC�'2c. �u �� / l ` r �*�e s roots ioYeSY I `0p\ I CULSS- Se• - IP- Vn1-�WGF , + 3 3 o• :?QGGt` 4 ZZl3L- (l-90Z10 $K Shart3 ^;eli : . 0. Sew .- o - • -�f/ Th , Audio-Visual - 3 ea. :, - , . ser-2x�!- 4,k) N o...Th^W j T ti,•or,eAc•--*44-•esieS a t r. ry 2 Clearout l' , -1'4' • N i. 1,200 Gallop Pre-Trash tar r�r \J / 4 \uWater BNR-.750 ATU Tank NI / U 0-),,oe= Gallon Puma Chamber / clitit :_.-..L. slQ C Valve Control Box 4.® J © I , Zoo r, r. Z-C . A, c;P pQiL of4f t if,. Scc a,4_ C bex- 2 cs-. CCU - 4r • s '" ,i i•+ .059 , A: 51'30343 e....PAULA JOY JOHNON •'iC ` S� IGi1�it j !1 gTC2�