HomeMy WebLinkAboutSWG2022-00345 - SWG As-Built - 5/2/2023 1
Mason County OSS Installation Report pg. 1 0., ,\ 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. Strong Rd.
City, State, Zip Shelton, Wa 98584 Installer Name Weather Tight Construction
Site Address XXX E. Strong Rd. Designer Name Bob Paysse
INSTALLATION CHECKLIST
III Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Gravity Pretreatment Type
>5 ft. from foundation? - ❑ N/A miYES ❑ NO
>50 ft.from wells? - - 0
Al 0
z >50 ft.from surface water? - - NI El
Cleanout between building and tank? - ❑ 111 ❑
U Tank baffles present? - - ❑ ® ❑
a24"access risers over each compartment?- - 0 In
W Effluent filter installed?- ❑ IN ❑
u
Septic tank capacity (working) 2250 gal Manufacturer Sound Placement
C) D-box water level and speed levelers used? - El N/A IN YES ❑ NO
DO Manifold/D-box accessible from surface?-
OOZ Check valves installed? -
- ❑ PI ❑
�Q ® El El
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?- I. N/A 0 YES ❑ NO
o >100 ft.from wells?- - 0 ® 0
W >100 ft.from surface water? - El
Z >10 ft. from potable water lines?- ❑ I ❑
e- > 5 ft.from property lines and easements?- - ❑ UI ❑
> 30 ft. from downgradient curtain/foundation drains? - UI ❑ ❑
Drainfield level and observation ports present -
❑ Graveless chambers or LE Clean gravel used? (check one) ❑ ❑ El
Proper cover installed over drainfield?- _ ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?- - 0 N/A ❑ YES ❑ NO
Y Pump tank capacity(flood) gal Manufacturer
Z
FQ- 24"access riser(s)and accessible from surface?- - El 0
o. Alarm or Control Panel Installed? El El ID
2 Control Panel equipped with Timer/ETM /Counter ❑ ❑ ❑
D
n- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
E 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
r . .
Mason County OSS Installation Report pg. 2 Parcel# 22128-77-00080
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - YES Q■ NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES Ei 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 6 manifold orientation&layout.Sept:a'pump tank location.North arrow,reserve drainfield.existing and proposed buldrngs.location of wells.waterlines.
wells.observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
aPPROVE
MAY 0 5 2023
ON CO
IASUNTY ENVIRONMENTAL HEALTH
JBW
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 attached Record Drawing is ecorate. form and attached Record Drawing is accurate.
C)46
Signature of Insta er Date tl
Scott Johnson ,t ; ;
Printed Name of Signee �� "'4
1�)f` .S
MASON COUNTY PUBLIC HEALTH
p, ROBERT H RarssE
The undersigned approves this Installation Report and 1 �
Record Drawing on behalf of Mason County Public EX�,REs
He •
Sign ur f Environmental 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
- a
SALE IR=my t
\ APPROX.
- STRONGROAD
r , . \••` C60'EASEMENT)
N
// \\ \ \\
/ /____-_,_. _____ ‘ \ \
ittAill
---- / _ \ / /
p‘xk - r ____ _ N. \
_� / \ \ /
p / V \ y\\
kIll
/ / / np1�p� �111 // // \\` \ \
N.
/ //
`.
, ' / INSTALLED DRAINFIELD
/ / // AS PER DESIGN
/ / / /
/ \r/ 1/1/S/E/PTIC TANK LOCATION.
SHOP UNDER
/ / (MAINTAIN 50'+ FROM PRIVATE WELLS)
CONSTRUCTION / / /
/ // /
,kD
, /
/ PPROVE
/ -';`�� ,/ MAY 0 5 2023
,' \/.._/ // // M Opi�NTY ENVIRONMENTAL HEALT
/, // \\ // / JBW
/ / \ /
�--, / \. �'
/ FUTURE
/G �j N.N. \/ rr
O N../\ HOME :'4'P.�, �'•
\\ LOCATION // - "
J 1 I
/
/ ‘1 POSSIBLE WELL SITE / �xPN,_�
\ (MAINTAIN 50FTTO TANK /
\ AND SEPTIC LINES) /
— /
CLIS TO.MER: DONALD PROUTY TEST H.`LE I: TEST H�LE 2 TEST 110(.1 3:
PIONEER DIGGING INC. ��I2 (,, �1 f2 C,
} PARCEL #:22128 77 00080 I>.�1(At:. I_>cxl.�r I2-48(m.•
SEPTIC DESIGNS ADDRESS: X)0XE STRONG ROAD 18+„.`\1P \\u
3083 E MASON BENI:-ON RD. GRAPEVIEW,WA 98540 DESIGNER: ROBERT H.PAYSSE DRICWMER THIS■ROTA SURVEY.REFERENCES INCLUDE.APPLICANTICOUN Tv PROVIDED
PLATS OR SURVEYS F,ELO MEASURE LBWS MC COUNTY OK OESION INTENDED FOR SEtt1C
OFFICE-3611426•18(13 F.A\• T )..i27.2353 PURPOSES 0N P$&Y PROPOSED OEVELO ND UM SE SL €CT TO OTHER
IIFEi': A$BUILT SCALE IR=50' DEPARTMEMIAGENCYRENEW OEGEP NOT RSPO6AU TOR SETBACKS UNRELTTD TO
SEPTIC COMPONENTS