HomeMy WebLinkAboutSWG2020-00644 - SWG As-Built - 8/14/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00644 Parcel# 12229-24-00010
Applicant Name Greg Allen Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 1914
City, State, Zip Allyn Wa, 98524 Installer Name Shumaker Construcion
i
to Address 233 Williams place Designer Name Pioneer Digging
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pretreatment Type
>5 ft.from foundation? - - ❑ N/A `-a YES_--_ `rsi No
>50 ft.from wells? - - 0 e 0
>50 ft.from surface water? - ❑ ■ 0
Z
i9 < Cleanout between building and tank? - _ ❑ IN
U Tank baffles present? - - 0 ® 0
17- 24"access risers over each compartment?- _ 0 e ❑
ul Effluent filter installed?- ❑ ■ ❑
cn
Septic tank capacity(working) 1500 gal Manufacturer HAGERMAM'S
0 D-box water level and speed levelers used? - - ❑ N/A a YES 0 NO
DO Manifold/D-box accessible from surface?- ❑ IN
-00-. -Check valves installed? -
vQ F-f
2 Transport Line Size 4" Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 0 3 ❑■ 4 0 5 0 6 ❑Commercial/Other
>10 ft.from foundation?- ❑ N/A ® YES 0 NO
>100 ft.from wells?- _ 0 ® ❑
--1 >10u ft.from surface water?- 0 N 0
'li >10 ft.from potable water lines?- - ❑ In 0
Z
Q 5> ft from property easements?
lines and El It El-
cc >30 ft.from downgradient curtain/foundation drains?- - 0 11 ❑
Drainfield level and observation ports present - - ❑ e ❑
0 Graveless chambers or 111 Clean gravel used? (check one) _•
Proper cover installed over drainfield?- 0
m •
Pump tank setbacks consistent with septic tank?- - a N/A 0 YES 0 NO
Y Pump tank capacity(flood) gal Manufacturer
Z
Q 24"access riser(s)and accessible from surface?_ - 0 0 ❑
0~. Alarm or Control Panel Installed? - - El 0
• control Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑
o
a Pump installed in ❑ Bucket or 0 On Block or 0 Other
a"• PumpMake/Model
0 Floats or El Transducer
d Tank draw down in/min Pump capacity qpm Squirt Height ft
Pump on time PumP P f! agpd
•A P.lZl:iv18 t
AUG 14 2023
MASON COUNTY ENVIRONMENTAL HEALTH
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Mason County OSS Installation Report pg. 2 Parcel# 12229-24-00010
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - 0 YES IN NO
If yas,please describe: :rl
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑ 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 Orainfeid d manifold orlen:afon&layout.Septic/pump tang location Noll arrow,reserve d•ainfield,obstng and proposed buildings,location of wets.waterlines.
weal,ot,la'v..on ports,cieanovts,ant other maintenance access points. Incomplete Record Drawirgs may create additiona delays in final installation approval and related permits
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u6 14 20Z3
MASON CO�0 ENVIRONMENTAL HEALTH
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® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INe CALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed la occoi-
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 Macon County Codes. State and Mason County Codes
i rurther certify that all information contained on this I further certify that all information contained on this
form and attached Rec Drawing is accurate. form and attached Record Drawing is accurate.
Signature of Installer Date y4 w
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Printed Name of Signee r: '� Ilr- ••
MASON COUNTY PUBLIC HEALTH l�I 4
2 5100317
The undersigned approves this Installation Report and 4 o:• ROBERT r1�' wrrssr "�
4.
Re Drawing on behalf of Mason County Public
H alth EXPIRES
C(5'I t'123
Sig to E 'ronmentai Health Specialist Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
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STREAM PER GIS ? SON c u TY ENVIRONMENTAL HEALTH
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EXPIRES
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CUSTOMER: TIFFANI ALLfN SCALE 1:100 �'rQs
PIONEER DIGGING, INC. PARCEL It:17?79-24{)00I0 TEST HOLE I: TEST HOLE 2
SEPTIC DESIGNS ADDRESS: XX WILLIAMS ROAD29+TILL 29+,TICLL
3083 E.MASON BF' ON RD. GRAPEVIEW.WA 98546 DESIGNER: ROBERT PAYSSE
OFFICE•360-4261803 FAX-360 427.2353 DESIGN PAGE RECORD DRAWING