HomeMy WebLinkAboutSWG2023-00161 - SWG As-Built - 9/27/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00161 Parcel # 52008-22-00330
Applicant Name Steve Tupper Subdivision (Name/Div/Block/Lot)
Applicant Address 343 W. Lake Nahwatzel Dr.
City, State, Zip Shelton,WA 98584 Installer Name Home Owner- Steve Tupper
Site Address 343 W. Lake Nahwatzel Dr. Designer Name Dale L.Tahia
INSTALLATION CHECKLIST
® Full System Installation 0 Tank(s)Only 0 Drainfield Only ❑Repair ❑Other
System Type Gravity Trenches Pretreatment Type
>5 ft. from foundation? - - ❑ N/A ®YES ❑ NO
>50 ft. from wells? ri VI �-- p1 ❑
>50 ft.from surface water? - i 11^�4 ` c
Z 1 1) `L. ` ® ❑
HCleanout between building and tank? - ---- ���fJJ - 0 I 0
U Tank baffles present? - i -SAP 12_? . . ® 0
a24" access risers over each compartment?-- ---- - - - ® ❑
W Effluent filter installed?- ray-_-� _ � ® El
N
Septic tank capacity (working) 1.250 gal Manufacturer Hagerman
El D-box water level and speed levelers used? - - ❑ N/A ®YES ❑ NO
oO Manifold/D-box accessible from surface?- - ❑ ® 0
mZ Check valves installed? - - I ❑ 0
6 Q
E Transport Line Size 4 inch Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 ■❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A In YES ❑ NO
CI >100 ft.from wells?- - ❑ ® ❑
W >100 ft.from surface water? - - ❑ IN
1i >10 ft.from potable water lines?- - 0 ® 0
Z > 5 ft.from property lines and easements?- - El 0 IDa > 30 ft.from downgradient curtain/foundation drains?- - In Ei 0
Drainfield level and observation ports present - - ❑ p1 0
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® 0
Pump tank setbacks consistent with septic tank? - - 0 N/A ❑ YES ❑ NO
• Pump tank capacity (flood) gal Manufacturer
Q 24" access riser(s)and accessible from surface?- - ❑ ❑ El
F-
a Alarm or Control Panel Installed? - - 0 0 0
2 Control Panel equipped with Timer/ETM / Counter- - 0 0 0
m
a. Pump installed in 0 Bucket or ❑ On Block or ❑ Other
d• Pump Make/Model 0 Floats or ❑ Transducer
Et.
• Tank draw down in/min Pump capacity qpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 52008-22-00330
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 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 Drairdield&manifold orientation&layout,septic/pump tank location,North arrow,reserve drainfield,existing and proposed buiklings,location of welts,waterlines,
wets,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
al 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
i further certify thatall"— tion contained on this I further certify that all information contained on this
form and a c er r rawing is accurate. form and attached Record Drawing is accurate.
/1 i wz-3 1
Lure of Installer TT ate ,,,r f
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Steve Tupper '
Printed Name of Signee I •" P >.s,>t
Uar • .idi"'^�rvyc,�� ,
MASON COUNTY PUBLIC HEALTH / s c ' 4,:,,,v0,..
The undersigned approves this Installation Report and ,�
te-
Record Drawing on behalf of Mason County Public ,:�c -..... !�
Health: i O "_ DALE L.TAHJA
�Ilth: lac& ED D SIG! JER tI
C" Y►�1 I ( ad- (73__ EXPlit.i.5: ;"
Signature of Environmental 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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APPROVED
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SEP 2 7 2023 . .
,! a MASON COUNTY ENVIRONMENTAL HEALTH
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