HomeMy WebLinkAboutSWG2022-00253 - SWG As-Built - 4/28/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00253 Parcel # 22006-30-92002
Applicant Name Megan &Jake Gould Subdivision (Name/Div/Block/Lot)
Applicant Address 881 E. Malaney Creek Rd.
City, State, Zip Shelton, WA 98584 Installer Name T.J. Goos
Site Address 881 E. Malaney Creek Rd. Designer Name Dale L.Tahia
INSTALLATION CHECKLIST
NO Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other
System Type Pressurized Trenches Pretreatment Type N/A
>5 ft. from foundation? - ,-7,- ill N/A ®YES El NO
>50 ft. from wells? - 1-- T k�4-L`�'I' it6 ® 0
Z >50 ft.from surface water? - - III ® ❑
H Cleanout between building and tank? - - --- _gQii `2 b 2023 - 11 ❑
Tank bafflespresent? - - --- - ■ ❑
V - ��'
a24" access risers over each compartment?- - - By-- � n IN 0
W Effluent filter installed?- •- 0 ® ❑
Cl)
Septic tank capacity(working) 1,250 gal Manufacturer Hagerman
0 D-box water level and speed levelers used? - - IllN/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- - ❑ II 0
o92 Check valves installed? - - ® 0 ❑
GQ
2 Transport Line Size 2 inches Schedule/Class Sch. 40
Bedrooms installed (check one) 0 2 ❑■ 3 0 4 0 5 0 6 0 Commercial/Other
>10 ft.from foundation?- - ❑ N/A E YES ❑ NO
CI >100 ft.from wells?- - ❑ ® ❑
W >100 ft.from surface water? - - El ® ❑
LL >10 ft. from potable water lines?- - ❑ [Il 0
Z > 5 ft.from property lines and easements?- - ❑ ® 0
> 30 ft. from downgradient curtain/foundation drains? - - 0 I II ❑
Drainfield level and observation ports present - - 0 0 ❑
® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ II ❑
Pump tank setbacks consistent with septic tank? - - 0 N/A ® YES ❑ NO
• Pump tank capacity (flood) 1.000 gal Manufacturer Hagerman
Q 24" access riser(s)and accessible from surface?- - ❑ II 0
F-
a Alarm or Control Panel Installed? - •- 0 IN 0
2 Control Panel equipped with Timer/ETM /Counter- - ❑ III ❑
m
a- Pump installed in ❑ Bucket or If On Block or ❑ Other
2 Pump Make/Model Liberty 280 0 Floats or ® Transducer
a
• Tank draw down 2 in/min Pump capacity 44 qpm Squirt Height 7 ft
Pump on time 2.8 Pump off time 5 hrs 57.2 min Daily flow set at 270 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# ---d`\ (^)."- ?-- 1 0(. {
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES ® NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 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: thalnfleld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays In final Installation approval and related permits.
APPROVE
APR 2 7 2023
MASOiN COUNTY ENVIRONMENTAL HEALTH
JBW
® Record Drawing Attached
i 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
Ihere 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
1 I further certify that all information contained on this I further certify that all information contained on this
form n attached Record Drawing is accurate. form and attached Record Drawing is accurate.
i.i
167). --- ''A43\),
Signature of Installer Date ` i 1Ii'
Fct4rocn. Goc, s 4... ,,,,.. ,
Printed Name of Signee �?,,..,
•MASON COUNTY PUBLIC HEALTH •.
a • \
r NO
The undersigned approves this Installation Report and ....fie"; 5t 402'I ` , .4
Record Drawing on behalf of Mason County Public ,• 0 "- DALE l.. TAH�A ''IA f
l l-,lth MIN D D SIGNER t
CO is "v L\kki 4 j v
Si. ati .f Environmental Health Specialist Date (stamp,signature and date)
• THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SDTE updated 8'21/2018
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