HomeMy WebLinkAboutSWG2022-00345 - SWG As-Built - 4/13/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00345 Parcel # 22128-77-00080
Applicant Name Donald Prouty Subdivision (Name/Div/Block/Lot)
Applicant Address 990 E. Stronq Rd.
City, State, Zip Shelton,Wa 98584 Installer Name Weather Tight Construction
Site Address cci (/ E. Strong Rd. Designer Name Bob Paysse
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Gravity Pretreatment Type
>5 ft.from foundation? - - ❑ N/A ®YES ❑ NO
>50 ft.from wells? - - ❑ ® ❑
Z >50 ft. from surface water? - - MI ❑
H Cleanout between building and tank? - - ❑ IN
U Tank baffles present? - - ❑ 0 ❑
1::: 24"access risers over each compartment?- - ❑ PI 0
cW Effluent filter installed?- - ❑ ® 0
Septic tank capacity(working) 2250 gal Manufacturer Sound Placement
9 D-box water level and speed levelers used? - - ❑ N/A II YES ❑ NO
DO Manifold/D-box accessible from surface?- - ❑ PI ❑
cc'2 Check valves installed? - ® ❑ ❑
0Q
2 Transport Line Size 4" PVC Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 ❑3 0 4 0 5 El 6 ❑Commercial/Other
>10 ft. from foundation?- - ® N/A ❑ YES ❑ NO
0 >100 ft.from wells?- - ❑ ® ❑
W >100 ft.from surface water? - - ❑ MI El
u. >10 ft. from potable water lines?- - 0 III ❑
Q Z >5 ft.from property lines and easements?- ❑ II
ce > 30 ft.from downgradient curtain/foundation drains?- - PE ❑ ❑
Drainfield level and observation ports present - - ❑ ❑ ❑
❑ Graveless chambers or IF Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?- - ® N/A ❑ YES ❑ NO
Y Pump tank capacity(flood) gal Manufacturer
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 ❑
D
n- Pump installed in ❑ Bucket or 0 On Block or ❑ Other
n' 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 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 22128-77-00080
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - El YES Q NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El 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. Typcal Record
Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location.North arrow,reserve drainfield,existing and proposed buildings,location of wells.waterlines,
wells.observation ports,cfeanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
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0 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
I further certify that all information contained on this I further certify that all information contained on this
form and attachedRecord Drawing is ecurate. form and attached Record Drawing is accurate.
Signature of lnsta er Date
k
Scott Johnson 7j' l' �kR •,
Printed Name of Signee i [!';o ' • !+ It
MASON COUNTY PUBLIC HEALTH A1'
The undersigned approves this Installation Report and �tto.• RoeER:°H iayssE �;
1.
Record Drawing on behalf of Mason County Public EXPIRES
Health:
C(
Signature ,It;) ironme� �, nta/Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 821'2018
SCALE I•=300' \\` APPROX.
\ STRONG ROAD
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// / IINSTALLED DRAINFIELD
/ / // AS PER DESIGN
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/ / / SEPTIC TANK LOCATION.
SHOP UNDER / (MAINTAIN 50'+ FROM PRIVATE WELLS)
CONSTRUCTION / /
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(MAINTAIN 50FTTO TANK / ExFI:_s
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CUSTOMER: DONALD PROUTY TEST HOLE I: TEST HOLE 2: TEST Ik"LE 3:
PIONEER DIGGING, INC. PARCEL 22128 n0008o 12I'«` (H2( S <}I'�,:
2(xlG\t� I260(,�1� 1248G\Is
SEPTIC DESIGNS ADDRESS: XXX E STRONG ROAD -18+cow'S\NL)
3083 IL MASON BENSL)N RD. GRAPEVIEW WA 9854( DESIGNER: ROBERT H.PAYSSE DECLARATIVE MS R NOT A SURVEY.REFERENCES iNCLUOE A►PUCANTRIOUNTY►ROUDED
PLATS OR SURVEYS VELD MEASUREMENTS ANO COUNTY OM.DEMON WRNDE0 FOR SEPTIC
��FFICE 3(x142G I8U3 FA\ 3Cx1427 2353 n /y PURPCSES ONLY PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER
SHEET: ASBUILT SCALE I =5V DFPARTUEM'ACEACV REVIEW DESCRIER NOT RESPONSIOLE FON U MW;UNMATED TO
SEPTIC COMPONENTS