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HomeMy WebLinkAboutSWG2023-00299 - SWG As-Built - 9/5/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION ('f, ., Permit Number SWG 2023-00299 Parcel # 32021-58-03042 Applicant Name MAX OMDAHL Subdivision (Name/Div/Block/Lot) Applicant Address 2001 E CRESTVIEW DR City, State. Zip SHELTON, WA. 98584 Installer Name ANDREW SPEAR CONSTRUCTIO Site Address SAME Designer Name CINDY WAITE INSTALLATION CHECKLIST ❑ Full System Installation ❑ Tank(s)Only IN Drainfield Only ❑ Repair ❑Other — System Type GRAVITY Pretreatment Type >5 ft. from foundation? - -- - - - - ❑ NIA ® YES ❑ No >50 ft. from wells? - ` fP" 11-W-- - - - ❑ I El Z• >50 ft. from surface water? - - - - - I I - - -- ❑ 0 El HCleanout between building and tank. -SE __5. 2 3- - - - ❑ II 0 U Tank baffles present? - - ❑ 0 ❑ n~. [.1a 24" access risers over each compart t?- - ❑ ❑ ❑ W Effluent filter installed?- - ❑ ❑ ❑ N Septic tank size 750 gal Manufacturer_ EXISTING --CI a D-box water level and speed levelers used? - - ❑ N/A YES ❑ NO XO Manifold/D-box accessible from surface?- - ❑ I ❑ hL 032 Check valves installed? - - ❑ ❑ Pi 0< 2 Transport Line Size 4" Schedule/Class _ 3034 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A ® YES ❑ NO >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - -- - El ® ❑ >10 ft. from potable water lines?- ❑ [11 ❑ Z > 5 ft.from property lines and easements? ❑ © ❑ Q ce > 30 ft. from downgradient curtain/foundation drains? • - - ® ❑ ❑ ca Drainfield level and observation ports present - [-] 0 ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ NI ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES 0 NO • Pump tank size gal Manufacturer_ < 24" access riser(s)and accessible from surface?- - ❑ ❑ ❑ H Cl. Alarm or Control Panel Installed? - - ❑ ❑ ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - - - -. - ❑ ❑ ❑ `\a. Pump installed in ❑ Bucket or ❑ On Block or ❑ Other aAP 0 7. , ❑ Floats or ❑ Transducer d Ta k'abkvlel W., -,: in/min Pump capacity gpm Squirt Height ft s LL sn,teg tF' UULI�i Pump off time Daily flow set at gpd Updated 8/21/2018 MASON COUNTY ENVIRONMENTAL HEALTH DJA Mason County OSS Installation Report pg. 2 Parcel # 32021-58-03042 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? 0 0 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: Drainfield&manifold orientation&layout,Septic/pump lank 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 penri's. 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 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 l further certify that all information contained on this I further certify that all information contained on this form and attache Record Drawing is accurate. form and attached Record Drawing is accurate. 3 wit ignat of Installe ate i 1�� Q •i�4,ct- %. . o�Jclvl Jp ee ✓ ,;'�Pof es� `�9a, 1 _ nN Printed Narhe of Signee - ti.\> �/, l/J ;I �;, . , �J ,��U MASON COUNTY PUBLIC HEALTH Pp ,, "; t s saoo4 �j The undersigned approves this Installation Report and .-cy' , ' o`' cl Y E. AITE �,1 UC s£A DESIGNER �It Record Drawing on behalf of Mason Co my Publicsen ,%`�+ `e`„" ` ` "`1 Health. 4SQNC Q✓ ExPIREs os o, `� o4N 2023 �i 71(5/ 97.3 ryE�`?fit;�'FNT4 Signature of Environmental Health Specialist Date C H'fr''u (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 • .S(. .7. . -- I ..,- ..._....., i c---. " : • ' (wi 1 •1.i 1.--'01.....L. I • . .......—............._ LI () ° — -... 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