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HomeMy WebLinkAboutSWG2024-00465 - SWG As-Built I Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00465 Parcel # 22029-78-50040 Applicant Name Michael Pearson Subdivision (Name/Div/Block/Lot) • Applicant Address 8371 SE Lynch Rd City, State, Zip Shelton, WA 98584 Installer Name County Line Development Site Address same-added ADU Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation El Tank(s)Only El Drainfield Only ❑ Repair ®Other Class B Waiver System Type Shallow Pressure Trench Pretreatment Type >5 ft. from foundation? - - - - - - ❑ N/A ■❑ YES ❑ NO >50 ft. from wells? - - - - ❑ 0 ❑ Z >50 ft. from surface water? - - - - - - —- ❑ CI EN :between building and t . - - CI- - - - �'L j- - ❑ 0 CU Tank baffles present? - - - - 1-�" - ❑ 0 CI d 24"access risers over each compa t?� - - - - - - CI CI Ili' Effluent filter installed?- - - ❑ ■❑ ❑ co Septic tank capacity (working) 1,064) -- gal Manufacturer Infiltrator C) D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑■ NO DO Manifold/D-box accessible from surface?- - ❑ 0 CI co Check valves installed? - a* f u•-"A'{- 4442`"~'K - ❑ ❑■ CI 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 0 2 El 3 ❑4 El 5 ❑6 El Commercial/Other >10 ft. from foundation?- • - ❑ N/A 0 YES El NO ID >100 ft. from wells?- - ❑ CI ❑ W >100 ft. from surface water? - - ❑ 0 ❑ u. >10 ft. from potable water lines?- - ❑ 0 ❑ ? > 5 ft. from property lines and easements?- - ❑ ❑■ ❑a CC a > 30 ft. from downgradient curtain/foundation drains?- - CI 0 CI Drainfield level and observation ports present - - ❑ RE ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ID ❑ Pump tank setbacks consistent with septic tank?- - El N/A Q YES ❑ NO Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator Z < 24"access riser(s) and accessible from surface?- - ❑ © ❑ a Alarm or Control Panel Installed? - - ❑ 0 ❑ E Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ n a- Pump installed in ❑ Bucket or 0 On Block or ❑ Other a. E Pump Make/Model Zoeller N152 ❑II=I Floats or ■ sducer 2. D Tank draw down 2.25 in/min Pump capacity n ut -1 11;h` � 9 ft Ai CI a Pump on time 1 min Pump off time JAN A' Daily flows '. 240 gpd ,A li i .i L,,,-.1 - Updated 8/21/2018 MASON COUNTY ENVIRONMENTAL HEALTH JBW Mason County OSS Installation Report pg. 2 Parcel# 02-a - Z - --S7)04+,0 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - O YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - O YES O NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to rt4ocate in the need of maintenance activities and future deveioprnent. Typical Record Drawings contain: Drainteid&manifold orientation&layout,Septdpurip tank location.North arrow,reserve dainfield,costing and proposed buildings,location cf wells,waterlines, weals,observaton ports,dpanauq and other maintenanrx access points. Incomplete Record Drawings may create additional delays in final installation approval aid related permits. 5, \Ike(--th\-ILCLA p, RovE MASON a).4:3 AN 1 1t{� :.. tirENV/RON • �w MENTAL HEAL 7-/-: Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that i installed the system in accordance with /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 1 fu er ertify that all information contained on this I further certify that all information contained on this fo attached Record Drawing is accurate. form and attached Record wing is accurate. Z- 2-Z-ZS Signature of Installer Date st 14'4 )'. lC,? MICHAEL LOVELY ue o, w,„ Printed Name of Signee • 3R- MASON U H r • •1. SO COUNTY PUBLIC HEALTH t' y� The undersigned approves this Installation Report and �• PAULA JOY J HNSON '. Record Drawing on behalf of Mason County Public • •• SEn Y) iGNE�i V _ Health: EXPIRES -16U i 5- Z(0 c_2,zfo S. a ' o Environmental Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upload 8l21/201t MIclnte..1 Pea4-Son r 2� 3'� ' ��-; �rcrr�l#ZZoZ�-76 '50a 1-10 .-c-,-.4,4),....5 ,.r-.3c,. gam-- 831t 5E Lyvicti, iZd. the1ionJw4 i85 Scale !zs ^ /00 tCa ;So Z°O c.0 C.-- — A 1517 .,,m`,Z 6 e,i _r-- v ('3� Audio-Visu�1.9 I �- -{o 1C!f i Cleanout ' �D V 3 2000 Callon Septic Tank `r -(3) 2- Compar=ent with i I Si 1 Effluent Filter ' O1000 Cron Pump CbP*�+ber 1 ----w� OValve Control Box i o ` -753% \ i A= IEST HOLE X1 : 0 24 5(.. ..i--coo t.5, } v-i-Lie 9 Ls us/ ?cake s- / r r i142; 3i0A*1\c' '' \ f' cirl Pri+wojry MO ‘41,0 \in \ i_ hq,.....sc \V\eS OPref V4-6"17,1 A \ , , , _ ‘,,-.,.. . ..'idk , N C1 M .y.' /1' P P A 0 V gi �`�� sloes, •;N'•�'j ` r.� y PAULA JOY JOHNSON .. ..\ •A1C�NSic:ATI;c 1JAN 1 ���F • MASON COUNTY ENVIRONMENTAL hE _ /-L-2, Siti 1 JBW Z'`A