HomeMy WebLinkAboutSWG2024-00249 - SWG As-Built - 6/17/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00249 Parcel # 420181290040
Applicant Name Kim Yong Koo Subdivision (Name/Div/Block/Lot)
Applicant Address 7480 W Shelton Matlock Rd Dayton Store
City, State, Zip Shelton We 98584 Installer Name Schoening Excavating LLC
Site Address 7480 W Shelton Matlock Rd Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation ®Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type Gravity Pretreatment Type
>5 ft.from foundation? - - -- -- - - -- ❑ N/A YES ❑ No
>50 ft.from wells? -- -- -- -- -- -_-- -- -- -- -- -- - - - - - - - - - -- -- --- - ❑ ❑
Z >50ft.from surface water? - - - - - - - - - - - - - - - - - - - - - - -- ❑ ❑
Cleanout between building and tank? -- - - - - - - - - - -- --• ❑ ❑
U Tank baffles present? - -- - - - - - - - - - - ® - - - -- ❑ ® ❑
a24"access risers over each compartment?- - - - - -({ -�-/Li ® ❑
W Ftfluent filter installed?-- - - - - - - - - - -
00a t� /1 ❑ o ❑
Septic tank capacity(working) t'lfi0 al Man Hagerman Pre Cast
O D-box water level and speed levelers used? -- -- -- --- - - 0 NIA ❑YES ❑ NO
J
QO Manifold/D-box accessible from surface?- -
- - - -- - - - - - - ® ❑ ❑
i mZ Check valves installed? -- - - - - - - - - - - - - - - - - - - - - - ---
❑ ❑
m<
f Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑3 ❑4 El5 ❑6 QCOmmerciallOther
>10 ft.from foundation?-- - -- - -- - - - - - - - - -- ❑ NIA BYES NO
>100 ft.from wells?- ------------ --- ❑ 0 El
J >100 ft.from surface water? -- -- -- -- ----- - - ❑ ❑ 0
u
ME >10ft.from potable water lines?- -------- ------------ - ❑ 0 ElQZ > 5ft.from property lines and easements?-- - - - - - - - - - ----- ❑ 0 El
C > 30 ft.from downgradient curtain/foundation drains?- - - - - - --- - ❑ 0 El
G Drainfield level and observation ports present - - - - - ❑ ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?-- --- - -- -- -- ----- -- ❑ ® ❑
Pump tank setbacks consistent with septic tank?---- 0 NIA ❑ YES ❑ No
Y Pump tank capacity (flood) aal Manufacturer
Q24"access nser(s)and accessible from surface?-- -- -- - -- -- -- El
Alarm or Control Panel Installed? ----- -- --- -- - - - -- -- - - ❑ ❑
Control Panel equipped with Timer/ETM/Counter-- - - - - - - - - - ® ❑ ❑
0- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a Pump Make/Model ❑ Floats or ❑ Transducer
IL draw down in/min Pump capacity apm Squirt Height ft
Pump on time Pump off time Daily flow set at opd
ueaem ei21rzore
Mason County OSS Installation Report pg. 2 Parcel it 420181290040
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - - - - -- -- - - -- 0 YES NO
If yes, please describe: Old tank cracked on bottom. New tank set and backflled old tank
Were all components pumped out and properly abandoned per WAC24fr272A-0300? -- -- - - -- YES NO
RECORD DRAWING
The Is a"Monday rocoN and must W accurate and tleurlpi enough to re4ecate In the need of maintenance anMeies and Nan development. Typical RecorO
nrawg6 Contain: Dainfieltl fl maniloN onenmeon It layout,Seplklpump lank location,Notlh arms,reserve draiMieltl,edsling and prcpcsed hullElys,location of wells,waterlines.
xelk,oEservaOon rods,Geamud,antl dhermainteroma access points. incomplete Record DrewNga may create eddillcnal tlelays in final Inslalbtion apparel and related pemnis.
E Record 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 cleare&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.
925 6.14•7,4
Signature of/nstaller Date
Brayden Schoening
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
k LLL'\� Ca (n�"
Signature of Environmental alth Specialist Date (stamp, signature and date)
{ THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE unti led w1cals
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oRAFT n Bv: 1250 S, 1250 S-T, m
PA B0R 30¢T BATTLE OROU D,WA 9B o.R.N. 1250 P& 1250 P-T
PHONE: (360 BBT-T FM: (360 W-7M $GALE: 3'
NTB IM(iERMA1I PPECA¢f
RECORD.DRAWING continued
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APPROVE®
JUN 0 6 2024
MASON COUNTY ENVIRONMENTAL HEALTH
RET
584
MASON COUNTY 415N6THELTON:STREET,SHELT967 ,EXT 400
SHELFAIR 36042T-4467,EXT 400
BELFAIR:360-2754487,EXT 400
Public Health & Human Services ELMA:360482-5269.EXT 400
FAX 360427-7787
5 Must meet mitigation to reduce tank setback to surface water to 25fl.
1)Extra protection of integrity of tank and joints fa) Waterproofsurface barrier applied to
concrete tank consistent with Manual of Concrete Practice ACI 515.1R. Flexible rubber
boots or compression seals meeting ASTM C 1644, or flexible couplings meeting ASTM C
1173 used for inlet and outlet connections to provide flexibility in case or tank settlement
while still maintaining a watertight seal. An approved double-wall fiberglass tank may be
used in lieu of a concrete tank. 2)Performance testing of tank 2a) Concrete tank tested
for water-tightness consistent with ASTM C 1227. Fiberglass tank tested for water-
tightness consistent with IAPMO/ANSI Z1000-2007. 3)Accessibility of tank for ease of
operation and maintenance 3a)Access openings at or above finished grade with lockable
lids or secured to prevent
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF 088.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND/OR DESIGN
APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.govlhealthlenvironmentallonsitelossdnspectlon-request.php or call:
360427.9670,extension 400.
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