HomeMy WebLinkAboutSWG2022-00189 - SWG As-Built - 8/24/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00189 Parcel # 220017600080
Applicant Name Edwin & Cheryl Knowles Subdivision (Name/Div/Block/Lot)
Applicant Address 300 E Appaloosa Drive TR8 Survey 7/127 SE SW(Lot 8)
City, State, Zip Shelton, WA 98584 Installer Name Mike Skinner
Site Address Same as applicant address Designer Name Richard Bazzell
INSTALLATION CHECKLIST
® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type Standard Gravity Pretreatment Type
>5 ft.from foundation? - - ❑ N/A ® YES ❑ NO
>50 ft. from wells? - ����� ❑ � ❑
Z >50 ft. from surface water? - 0 ❑ ® ❑
H Cleanout between building and tank? - - - - - -�U�1 j 7()z3 ❑ IR ❑
U Tank baffles present? - - ❑ ® ❑
a24" access risers over each compartment?- ': - ❑ II El
cW Effluent filter installed?- - ❑ Ill
Septic tank capacity (working) 1250 gal Manufacturer Hagerman (concrete)
I D-box water level and speed levelers used? ❑ N/A ® YES ID NO
xej OO Manifold/D-box accessible from surface? ❑ I ❑
OOZ Check valves installed? - - ❑ ❑ II
0 Q
2 Transport Line Size 4" Schedule/Class 3034/SCH40
Bedrooms installed (check one) 1::1 2 0 3 pip II , s
J '- ial/Other
>10 ft. from foundation?
AUG 4 2 • :N/A ,f ' ® YES ❑ NO
®
� >100 ft. from wells? - ❑
''"_
>100 ft. from surface water? - MASON-GGv% IJ�/IROIt`i'r__c 0 ❑
u. >10 ft. from potable water lines?- JBW❑ it ❑
Z > 5 ft. from property lines and easements?- - ❑ It 0
Q
c4 > 30 ft. from downgradient curtain/foundation drains? - - ❑ a ❑
CI
Drainfield level and observation ports present - - ❑ MI ❑
• Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - - ® N/A ❑ YES ❑ NO
• Pump tank capacity (flood) N/A gal Manufacturer N/A
< 24" access riser(s)and accessible from surface?- - ® ❑ ❑
F-
a Alarm or Control Panel Installed? - - 0 ❑ ❑
2 Control Panel equipped with Timer/ ETM /Counter- - • ❑ ❑
m
n- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other N/A
a' Pump Make/Model N/A ❑ Floats or ❑ Transducer
a
Tank draw down N/A in/min Pump capacity N/A gpm Squirt Height N/A ft
Pump on time N/A Pump off time N/A Daily flow set at N/A gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 220017600080
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES ■0 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ 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: Drainfield&manifold orientation&layout,Septic/pump tank location.North arrow,reserve drainfield.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 related permits.
P
R
Afec, UG 2 4 202
V3 ED
"c'�COUNTy ENVIRONIt ENTAL HEALTH
JRW
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
1 further certify that all information contained on this 1 further certify that all information contained on this
form and att ched Record Drawing is accurate. form and attached Record Drawing is accurate.
vvl 4d ` z i'►t,
Signature of Installer Date 0 f►
4445-
Mike Skinner Ave ►►
Printed Name of Signee r l� t+4� Jba
'NP ►
MASON COUNTY PUBLIC HEALTH VThe undersigned approves this Installation Report and ;• �21��712gtl,
Record Drawing on behalf of Mason County Public O RICHARD L BAZZEI.I
H Ith LICENSED DESIGNER `
\m9.7_____ ±,: -&-cs•csccvSN'S.S.C..A., si 0
4 , 2.j4(,2, AC-7( , ,
.4 )Y---e2—:7 - . •CheZ?"/
Si atu vironmental 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
O __ __ _ �� 318.36' •
rn 1 't.;
8cn O ism
r , \
"al NOo I
ox
\ \ i m FA f2
\ I n 0 mr
\rD R s
---77
�•,xxmI yC------------c --- ' \ '\
1
\-----Z _ —
N 0
pz�9 U
-tt+0
1(:) 1
8 4 1 I
o qZ 145'•10' 1 145'-10' L
Ico
r 'N ,
N $ y �� I
s -qY I T
y \y I DJ
%
I m
p 9 '': II
0
1, 10
1 p
1 .
cA
c. CD
m1 1 iSt
NI 1y I w
'1,y I o
D11
I % I V J
I SLOPE ,.L I I
I ,m I IT 01� IJ�J
I 1, /1. I — �Z^
I — I I- VJ
rr - ��' 1 ', Ti
SLOPE I x II 'y` I H
I Er1
,
[ L1...
—J J j Z
I
, 1
''1
I o og , I
�, 1 1
c SLOPE 1l 1
* o c 1
., I 24 NO toil'^ ll
p m 1 1
LI 1 i m y I
mo
1
44 1
l
320.18' m �'
rg ,iiw
rn M po
m T.
AM _— —— —— EAST APPALOOSA DRIVE _— —_
� m
7.1
I m
m
_ I I o
• o8 I I 1
F m
A § > fi O m
m -A p
O
Z
5 m
Cn Cf) Cn 0 M 13 t 3211 13 r... -0 __,
M CD N Q O X
CD C...) O O� n
co cn �? Pr
Q m o in ---1 m
Z Z Z D u) � � _ - kali
I 3 3 Qo r. —4 C i. ` o 0 -0 Cr
p ,..7M
CD
CI to
t/i C N co
��4�i�� v 8 0 *`.1�
~ gC p 11/11110
zInc
irA f r.rot
N O W oft_
D * D
rn . Z
0!.. '. .nii
m -is_
D A
v
' 111:::,
Ka -(
N = m_ ,Ii