HomeMy WebLinkAboutSWG2023-00248 - SWG As-Built - 7/20/2023 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SING 2023-00248
Parcel # 32028-75-00010
Applicant Name SALLY SHEETZ Subdivision (Name/Div/Block/Lot)
Applicant Address 71 SE MILL CREEK RIDGE
City, State, Zip SHELTON, WA. 98584
Installer Name
Site Address SAME
Designer Name
INSTALLATION CHECKLIST
® Full System installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair
System Type GRAVITY ❑ Other
Pretreatment Type
>5 ft. from foundation? - -
>50 ft. from wells - -- El N/A YES ❑ NO
Z >50 ft. from surface water? - - _ _ _ _ ElCleanout between building and tank? - -. _ _ _ ._ _. _ ❑ I El
o Tank baffles present? - _ _ _ ❑ ❑
a24" access risers over each compartment?- - -- _ El ❑
LLJ Effluent filter installed?- ❑ 0 ❑
❑ 0 ❑
Septic tank size 2., 0 - gal Manufacturer t-}ct {vy`uYA re„ r
0 D-box water level and speed levelers used?
DO Manifold/D-box accessible from surface? - - - _ _ _ ❑ N/A YES El NO
OQCheck valves installed? - - - _ _ _ _ _. _ -_ ❑ 0 ❑
Transport Line Size 4 ❑ El ❑
Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 El 6
I >10 ft. from foundation?- ❑Commercial/Other
0 >100 ft. from wells? - ❑ N/A Li YES ❑ NO
W >100 ft. from surface water? El0 ❑
>10 ft. from potable water lines?- -- _ El I ❑
> 5 ft. from property lines and easements? ❑ 0 ❑
0 Q ❑ 0 ❑
> 30 ft. from downgradient curtain/foundation drains? -
Drainfield level and observation ports present - - _ _ _ ❑ 0 El
❑ it ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?-
Pump tank setbacks consistant with septic tank'? - _-
Z Pump tank size ❑ N/A ❑ YES NO
gal Manufacturer
< 24" access riser(s) and accessible from surface?- CO �'
7.
d Alarm or Control Panel Installed? - _ _ _ El ❑ Ell E Control Panel equipped with Timer/ ETM/Counter- - - - - - -_ . - - ❑ 0 ` P
0_ ❑ On Block or ❑ Other i
Pump installed in ❑ Bucket or ❑ t c:
CIl�
Pump Make/Model_ El Ici:11
— — ❑ Floats or ❑ Transducer
a. _Tank draw down in/min Pump capacity t r
__gpm Squirt Height ft 1
Pump on time Pump off time
-- Daily flow set at gpd
Updated 8/21/2C1d
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Mason County OSS Installation Report pg. 2 Parcel # 32028-75-00010
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project'? - -
YES II NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246 272A 0300? 0 YES El 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 Drainfreld&manifold orientation&layout,Septicipurnp tank location.North arrow reserve drainfield.existing and proposed b i dings.location of wells.waterlines
wells.observation ports.cleanouts.and other maintenance access points Incomplete Record Drawings may create additional delays ut final installation approval and related permits
� ,Al Ply SYeb c) Q-r 12� clef' Id
® Record 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
l 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.
Signature of Installer Date i- 1
•117
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Printed Nar,4e of Signee F 1
MASON COUNTY PUBLIC HEALTH aresl 'f
The undersigned approves this Installation Report and i _ 51 18A �.
oy CIND E.WAITE
Record Drawing on behalf of Mason County Public , LICENSED DESIGNER �'�
He �Li�tcc_ cc v`, `�
EXPIRES OSitO.
Sign ure E vironmental Hea th Specialist Date
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upoated 8'21/2018
4.
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