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Home My WebLink AboutSWG2019-00146 - SWG As-Built - 6/28/2023 4- . ............. . ....... ..... Mason County OSS Installation Report pg. 1 APPLICANT/ PERMIT INFORMATIO MASON COUNTY PUBLIC HEALTH Permit Number SWG 2019-00146 Parcel it/ 22133-76-90042 N Applicant Name Jerry Schaelai Subdivision (Name/Div/Block/Lot) Applicant Address 61 E. Spencer Ridge Place City. State, Zip Shelton,WA 98584 Installer Name Dave Young Site Address 61 E. Spencer Ridge Place Designer Name Dale L. Tahla INSTALLATION CHECKLIST is Full System Installation 0 Tank(s)Onty ❑Drainfield Only ❑Repair 0 Other System Type Gravity Trenches Pretreatment Type >5 ft.from foundation'? - 0 wA II YES 0 NO >50 ft.from wells? - ❑ II 0 Z >50 ft.from surface water? - . 0 11 0 H Cleanout between building and tank? - . CI 11 ❑ U Tank baffles present? - - 0110 a24'access risers over each compartment?- 0 ® 0 W Effluent filter installed?- -- U 0 0 CO:., Septic tank capacity(working) 1.250 gal Manufacturer Sound Placement 0 0-box water level and speed levelers used? ❑ NIA YES El NO pA. 0 MantloldfD-box accessible from surface?- - 0 MI El Check valves installed? - IN ❑ Transport Line Size 4 Inch Schedule/Class 3034 Bedrooms installed(check one) ❑2 ©3 ❑4 ❑ 5 ❑6 0 Commercial/Other >10 ft.from foundation?- - ❑ N/A YES ❑ NO CI >100 ft.from wells?- - 0 Ell 0 W >100 ft.from surface water? . - 0 ® 0 Li >10 ft. from potable water lines?- - 0 NI 0 Z- > 5 ft. from property lines and easements?- 0 NI ❑Q ec >30 ft.from downgradient curtain/foundation drains?- - 0 IN 0 Drainfield level and observation ports present - - 0 PI 0 ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 II 0 k setbacks consistent with septic tank? - - ❑ N/A s__ 0 NO NC Pump tank capaaty ocfas gal Manufacturer 61/4.(.t`nt1--1. Z < 24`access riser(s)and accessible fro ?- I.__ _- ❑ ❑ a. Alarm or Control Panel Installed? - - -- _ _ _ - ❑ ❑ ❑ 2 Control Panel equipped with Timer/E ounter- 0 0 M CI- Pump installed in ❑ Bu or 0 On Block or ❑ Other a Pump Make/M ❑ Floats or ❑ Transducer d Tan df w down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updaiod 62112018 , • ...,...., . . InstaliatiOn R•Port pg. 2 • ,.,-:. '. .. ,,,,,,,,,,.. -k. . -. , - . P • Patin'R ..., vvoileni :CORD _ . abanftned Os Pelt or this Pitint" ' - - were existno*soft tets t- , .........._ _.---_ 0 YES C3 HO ..°' were a cariporments pumped out ond prop•tty otiOntkliond fwtf WAC446 1 i 7A-0,0)? •,., R4C44C)DRAWING Sitihk I,• Amore and nook te IliOnorlft*rat••PrAlP•••••••••1*******"**Iti af mablis"Ille, 11111416.8fid 0400041"fla"..frositorod"."1"_ t.ir,cago ofwallsTYPICa;setedeilPI"Mni I d waimilkod vo•Killan A layout SaptiOpurnp lank iocalton.North attow.(*two too , fricompleols Fbitoord Drewingot inny crests arklikmao Otsisry*04*WO infitl#P*M4 Worm*sots fP•1104 OPMe•- ,-. is 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 dewed/approved by both the designer shown here have been clearediapproved 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 Masan County Codes /further certify that all Information contained on this I further certify that all information contained on this * f att Rc.., ird wing is accurate, form and attached Record Drawing is accurate. Vj , signature of Installer Date i 4 V s,. A 41-)101 Li ouny 44.4L7 '•)"'"i Printed Name of Signee MASON COUNTY PUBLIC HEALTH ' ' -,..s • , c.,-'. ,$:- ,,.'"c• !"/=*, The undersigned approves this Installation Report and ...'17-12.1.\ '''''' \,4\kci.:.r\ ,-----_;, f . ._14 Record Drawing on behalf of Mason County Public .-- '''' 'It2., •t's Health; TA , ... , . 55-11Y1 (23 ... , , , Signature of Erwin:mental Health Specialist Date ,.. (stamp, signature and date) THIS FORM MAY BB SCANNED ARO AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE "14469°8121"e 4 _I - -IN' ! -, t'M\c.ScAr\ \S\ Pv,CO-cs \)P3n;m3 - rc A? i-k,,,,- C.) \c\k,- 00\ k \ ( ' 1 0, Al , 0 £16/ 0gNOS' j. -71 fil. n 51 a) 9-1(11 P rc," z ` • -- 1 *1/' . r 'Ck' ?ii i"W:e/1;-(11-94/ / --C'es\S-- Y / i-7 , / / / ' ' / / e Ye i 1 ?" rr dit ) APPROVED al 6 JUN 2 8 2023 .t MASON COUNTY ENVIRONMENTAL HEALTf, /- RET y A jt --,,- S >tc-ce__.\- ?)\cpy__. r Nokcg__ ar,„,4<z ' %IP4, ,ii-,,,,-4 1-„, ,..„<<%,,,,. \„,4„..., 4. ,,,, ..., 14 ,,NNAV`',),,, it i 1' a:... .:si 154 - l!! . -•+ , r 11 cam.. .