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HomeMy WebLinkAboutSWG2019-00339 - SWG As-Built - 4/14/2026 VJL5V 1; k.J L� �! 1! i APR 022026 • By Mason County OSS Installation Report pg. 1 MASON CO J�BLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2019-00339 Parcel# 42001-34-00060 Applicant Name Shannon Johnson Subdivision(Name/Div/Block/Lot) Applicant Address 502 Laurel St. City, State, Zip Shelton WA 98584 Installer Name H2F 2019 / Wes Graves 2026 Site Address 1438 E.Shelton Springs RD. Designer Name Adam Hunter INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pre ur Pretreatment Type N/A >5 ft.from foundation?- -" - - ❑ N/A I YES ❑ No >50 ft.from wells? -- � pl - ❑ 0 ❑ Z APR-Q-f 0 -- ❑ 0 ❑ >50 ft.from surface water? ------4i4- 6 FQ- Cleanout between building and tank? ----- -- ---- - -- ❑ 0 ❑ U Tank baffles present? ----------- ❑ 0 ❑ a24"access risers over each compartment? - -- - - --- ❑ 0 ❑ W Effluent filter installed?--------------------------- ❑ 0 ❑ Septic tank capacity(working) 1060 gal Manufacturer Infiltrator 93 D-box water level and speed levelers used? --- --- --------- 0 N/A ❑YES ❑ NO DO Manifold/D-box accessible from surface?------ ----------- O ❑ 0 DaCheck valves installed? -------- ------- ----------- ❑ 0 ❑ M Transport Line Size 2" Schedule/Class 200 Bedrooms installed(check one) ❑ 2 ❑3 0 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?---- -, ❑ N/A ❑■ YEs ❑ NO �i � R a >100ft.fromwells?------- �- a , 1 t ■ W >1 00 ft.from surface water?-- - ,r.., ------------- - 0 ❑ ti >10 ft from potable water lines? - " ur-- -1-/` -- jD 0 ❑ Z >5 ft.from property lines and ease Imi R9N?G0b'N r i�GIF7('iNTKNTAL HEALT ® O >30 ft.from downgradient curtain/foundation drain --------- Drainfield level and observation ports present -------------- ❑ 0 ❑ ❑ Graveless chambers or W Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ Iii ❑ Pump tank setbacks consistent with septic tank?------------- p ❑ N/A ❑ YES ❑ NO Pump tank capacity(flood) 1060 gal Manufacturer Infiltrator FZQ- 24"access riser(s)and accessible from surface?------------- ❑ 0 ❑ IL Alarm or Control Panel Installed? --------------------- ❑ © ❑ Control Panel equipped with Timer/ETM/Counter----------- O 0 ❑ I- Pump installed in ❑ Bucket or ❑■ On Block or ❑ Other iLPump Make/Model Zoeller ❑■ Floats or ❑ Transducer p'- Tank draw down 3" in/min Pump capacity gpm Squirt Height 2 ft Pump on time 1.4 Pump off time 4 Daily flow set at 480 gpd Updated 812112018 Mason County OSS Installation Report pg. 2 Parcel# 42001-34-00060 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- ❑ YES X NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- ❑ YES 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: Drainfieid&manifold orientation&layout,Septic/pump lank location,North arrow,reserve dralnrield,existing end proposed buildings,location of wells,waterlines, wells,observation ports,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays In final Installation approval and related permits. r/ r,{CA/�1C$. ./.- ✓11� s��f'/-e4 /"IVi.. er/rr✓{f 0L APR °'.6 ��R+ fit 1t{ MASON COUNTY ENVIRONMENTAL HEALTH ecord 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 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate. 03-20-202E Signature of It taller Date 17_/i Wes Graves Printed Name of Signee � t-�. "° "< MASON COUNTY PUBLIC HEALTH The undersigned approves this installation Report and `' �;uo;I:• 4 ADA.IA J.ill; .iLR Record Drawing on behalf of Mason County Public i ia'�i 'c i ;'.' { He gi_/q- t.; i. lL Signfturpkvironmenta1 Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121120113 • RECORD:DRAWING continued jL i ± L -I! 49� 335, 4 BDRM RES f 0 PUMP CHAMBER SCALE-1'=100'-0" ) SITE IS FLAT SEPTIC TANK TUBOUTl CLEANOUT TIGHTLINEPORT G�*=.M •'�'• DRIVE v �i/ G 4`; a .Ui EXISTING BARN(fO BE REMOVED) �`=`�-<`•'''+ 7:�'�t'' SCALE-r30'-0" I 1 m ELL +y� 4 BDRM RES ��' •� DRAINFI ID AREA \ wr SEE DETAIL cP I G � ' PRESSURE TEST COMPLETED BY INSTALLER W q SQUIRT HT: 24" ) m-y DRAWDOWN: 3INIMIN 2HE LTON SPRINGS RD TIMER SETTINGS- ON: 1.4MIN OFF: 4HRS m s JIM HUNTER&ASSOC. CONTRACTOR P.O.BOX 162,OLY,WA 98507 H2F 0410 (26 753-1226 JHANDASSOCIATESQHOTMAIL.COM INSTALL DATE 313/20 RECORD DRAWING SITE ADDRESS/LEGAL 1438 E SHELTON SPRINGS RD y s. OWNER- SHANNON JOHNSON FINAL DATE- 315120 TP# 420013400060 SITE# SWG201900339