HomeMy WebLinkAboutSWG2023-00148 - SWG As-Built - 9/11/2023 Mason,County OSS Installation Report pg. 1 CC. MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00148 Parcel # 32022-50-00900
Applicant Name GARTH WALLACE Subdivision (Name/Div/Block/Lot)
Applicant Address 295 SE BAYVIEW RD
City, State, Zip SHELTON, WA. 98584 Installer Name WORKMAN CONSTRUCTION LLC
Site Address SAME Designer Name CINDY E WAITE
INSTALLATION CHECKLIST
® Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type SUB SURFACE DRIP Pretreatment Type BNR 500 NUWATER
>5 ft. from foundation? - - ❑ N/A El YES ❑ NO
>50 ft. from wells? - - ❑ ❑ ❑■
Y >50 ft. from surface water? - - ❑ ■❑ ❑
Z
H Cleanout between building and tank? - - - El ■❑ ❑
o Tank baffles present? - - - - ❑ ■❑ ❑
d24" access risers over each compartment? - - ❑ El
W Effluent filter installed?- - El El
ci) Septic tank size t):01-1r,e4A clb gal Manufacturer 1.6gri
o D-box water level and speed levelers used? - - ■❑ N/A ❑ YES ❑ NO
J
XO Manifold/D-box accessible from surface?- - ❑ ❑ ❑
mZ Check valves installed? - - ❑ ❑ ❑
C]Q
E Transport Line Size 2 Schedule/Class SCHEDULE 40
Bedrooms installed (check one) ❑ 2 1113 ❑4 ❑ 5 ❑6 ❑CommercialiOther
>10 ft. from foundation?- - ❑ N/A ❑ YES ■❑ NO
0 >100 ft. from wells? - i1 [E 4 4 4]-Z-E5 ❑ ❑ ■❑
J >100 ft. from surface water? - ❑ ❑
W 111
Li >10 ft. from potable water lines?- _ AU& 1 s Lt��3 ul ❑ ■❑ ❑
Z > 5 ft. from property lines and easements? ❑ ■❑ ❑
Q
ce > 30 ft. from downgradient curtain/foundatio 8rtaius?---_ 0 ❑ ❑
Drainfield level and observation ports present - - 0 ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used'? (check one)
Proper cover installed over drainfield?- -- - - - 0 ❑ ❑
Pump tank setbacks consistant with septic tank? ❑ N/A Q YES ❑ NO
• Pump tank size Vllie0 gal ManufacturerVA, ,,--i,AA ....1.
< 24 access riser(s)and accessible from surface?- - ❑ ■❑ ❑
a Alarm or Control Panel Installed? - - ❑ 0 ❑
• Control Panel equipped with Timer/ ETM / Counter- - ❑ • ❑ \.
\,k
CI_ installed in ❑ Bucket or ❑ On Block or (A Other tr .i
a'E Pump Make/Model ❑ Floats or ❑ Transducer
II //
d Tank draw down ;SC( in/min Pump capacity 1100 lj gpm Squirt Height(/- ft
Pump on time ID vvvl v\ Pump off time 2,- " -`) Daily flow set at -7 7p gpd
Mason County OSS Installation Report pg. 2 Parcel# 32022-50-00900
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project'? - _- -
If yes, please describe: Q YES NO
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. Typica i Record
Drawings contain. Drainfield&manifold orientation&layout.Septic/pump tank location.North arrow reserve grainfield.existing and proposed buildings.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 relate Q 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 deviation*
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 accurate. form and attached Record Drawing is accurate.
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Signature of Installer Date1,
----, • ,
Printed Name of SigneeAF4�4-. * i:s., . `t tip)
s? (-'4_ yo +11 ,-
MASON COUNTY PUBLIC HEALTH s 1/ '\\ '
The undersigned approves this Installation Report and z 5100418 c<,�j
Record Drawing on behalf of Mason County Public r CINDY E WAITE �1
r LICENSED DESIGNER 1'
Healt Atom l& ��% .� % %
j Lxi'IRLS J510,
(- / t i I Mtn 1 i), �1►—Z 3
Sign ure ill ironmental Health Specialist Date
(stamp, signature and date) frAA
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE lJrdntece d
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MASON COUNTY ENVIRONMENTAL HEALTH
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