HomeMy WebLinkAboutSWG2022-00417 - SWG As-Built - 4/26/2023 T
Mason County OSS Installation Report pg. 1 0 C MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2022-00417 Parcel# 22127-75-90152
Applicant Name Lopez Javier&Graciela Subdivision (Name/Div/Block/Lot)
Applicant Address 460 SE Fire Weed Rd
City, State, Zip Shelton Wa Installer Name Shumaker Const.
Site Address 110 E Passage view rd Designer Name Jim Zimny
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair
❑Other
System Type Pressure Pretreatment Type
>5 ft.from foundation? - - ❑N/A III YES ❑ NO
>50 ft.from wells? - - ❑ e ❑
Z >50 ft.from surface water? - ' EPC,ME W-E❑ • 0
Cleanout between building and tank? - l•L� ❑
-
tJ Tank baffles present? - •I -APR 6-J LJ 11 Eld 24"access risers over each compartment?- 3 - ElIIII
u.l Effluent fitter installed?- BYT ❑ 11 0
V) El
Septic tank capacity(working) 1250 gal Manufacturer Hagermen's
5 D-box water level and speed levelers used? - - e N/A ❑YES ❑ NO
OLL
O Manifold/D-box accessible from surface?- - 0 II El
GQ Check valves installed? - - 0 El
III
a Transport Line Size 2'
Schedule/Class sch 40
Bedrooms installed (check one) 0 2 ®3 ❑4 0 5 0 6 ❑Commercial/Other
>10 ft.from foundation?- - 0 N/A II YES 0 NO
0 >100 ft.from wells?- ID III El
W >100 ft.from surface water? - El
II
Z >10 ft.from potable water lines?- - [3 IS ❑
e >5 ft.from property lines and easements?- - El III El
>30 ft.from downgradient curtain/foundation drains? ❑ II ❑
Drainfield level and observation ports present -
❑ Graveless chambers or J Clean gravel used? (check one) PI
Proper cover installed over drainfield?- - ❑ N ❑
• Pump tank setbacks consistent with septic tank?- - 0 N/A ® YES ❑ NO
Y Pump tank capacity(flood) 1250 gal Manufacturer Hagermen's
Z
Q 24"access riser(s)and accessible from surface?- - ❑ ■ ❑
H Alarm or Control Panel Installed? -
2 Control Panel equipped with Timer/ETM/Counter- ❑ ® 0
n
4. Pump installed in a Bucket or 0 On Block or
❑ Other
f1 Pump Make/Model liberty 280
� 0 Floats or 0 Transducer
Tank draw down 1.5 in/min Pumpcapacity d. P crtY 50 qpm Squirt Height 9' ft
Pump on time l ' 5 P\;'i dad Pump off time Y S Daily flow set at Z 20 qpd
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Mason County OSS Installation Report pg.2 Parcel tt 22127-75-90152
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - YES Ei NO
If yes, please describe: _
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES Q NO
RECORD DRAWING
Thia is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and tenure development. Typical Record
Drawings contain Dra:nficid tt mandold orrentaton&layc,rt.Septeptanb tank location.North arrow.reserve etanteid.ecsterG and Crpposed buds rgs location of ads.waterline&
wags.observation ports,deanouts.and other ma;ne-ante access points Incomplete Record Drawings may crease addrt,onal dda"s m final cntmtabon approve,and related penes.
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111 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that 1 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
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.
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Signature of Installer Date
41brotAs StLtAtA A. r ,fit
Printed Name of Signee :`� �l
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MASON COUNTY PUBLIC HEALTH . �ZP
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The undersigned approves this Installation Report and o�. z,r., t
Rec. • Drawing on behalf of Mason County Public LIC ;�I E GNER a
ea/th. t.�:.r. : r
*IA l'Ari) Lt� -�� g1,-2(93
Sig :t ,yr-' vironmental Health Specialist Date (stamp. signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated8217J18
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