HomeMy WebLinkAboutSWG2022-00149 - SWG As-Built - 8/19/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
Permit Number SwG 2022-00149 Parcel# 22005-52-00017
Applicant Name Susan&Dwain Friedlander Subdivision (Name/Div/Block/Lot)
Applicant Address 21 E Loop Cut-Off Rd.
City, State, Zip Shelton, Wa 98584 Installer Name Active Underground LLC
Site Address Same as Above Designer Name Dale Tahja
INSTALLATION CHECKLIST
W Full System Installation 0 Tank(s)Only 0 Drainfield Only 0 Repair 0 Other
System Type Gravity Pretreatment Type
•
>5 ft. from foundation? - - ❑ NIA ®YES ❑ NO
>50 ft.from wells? - - ❑ ® ❑
Z >50 ft. from surface water? - - 0 II El
Cleanout between building and tank? - - ❑ ® ❑
0 Tank baffles present? - - ❑ ® ❑
L24"access risers over each compartment?- - ❑ IN 0
W Effluent filter installed?- - 0 ® ❑
N
Septic tank capacity (working) 1200 gal Manufacturer SPS
CI 0-box water level and speed levelers used? - - ❑ N/A I. YES 0 NO
oO Manifold/D-box accessible from surtace?- -
0 PI El
u.
Oj Check valves installed? - - ® ❑ ❑
❑a
2 Transport Line Size 4" Schedule/Class SDR35
Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 0 Commercial/Other
>10 ft. from foundation?- • • - ❑ NIA ® YES (] NO
0 >100 ft.from wells?- p - _ - El ® ❑
11.1 >100 ft. from surface water? - f! -L 7-/-/-- 0 LiElu. >10 ft.from potable water lines?- - if - ❑ III El
4 Z > 5 ft.from property lines and easement c---l-U-1'a 2-i82.2- .i i - ❑ II
it > 30 ft.from downgradient curtain/foun lion drai - -1 - 0 IN
0r _ - El El El
level and observation ports p sent-
® Graveless chambers or 0 Clean gravel use ? >l
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - - 111 tita ❑ YES ❑ Ito
ZPump tank capacity(flood) gal Manufacturer
Q 24"access riser(s)and accessible from surface?- - 0 ❑ 0
H
a Alarm or Control Panel Installed? - - El ID El
Control Panel equipped with Timer/ETM/Counter- - ❑ 0 0
°- Pump installed in 0 Bucket or ❑ On Block or ❑ Other
r't' Pump Make/Model ❑ Floats or ❑ Transducer
a _.
Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at qpd
Updated 8f212018
Mason County OSS installation Report pg. 2 Parcel# 22005-52-00017
='ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES ® NO
if yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - [] 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: Drainfield 8 manifold orientation F.layout,Septic/pump tank location,North snow,reserve drainfield,existing and proposed buildings,location of wells,watcrtines,
wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays In final installation approval and related permits.
M.
II 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 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 /further certify that all information contained on this
form and attached- cold Drawl ¢mate. form and attached Record wing is accurate.
07/15/2022
gna re of Installer Date
James Medcatf 04ti
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
v•
Or 51 C�;; •
.4,�The undersigned approves this installation Report and ? ALE L. TAHJA
•
Record Drawing on behalf of Mason County Public SIGNER
Health: -•
ki*--jNoNivC-jYr\ °O
Signature of Environmen 1 Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updatedaal¢ots
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