HomeMy WebLinkAboutSWG2021-00289 - SWG As-Built - 11/29/2023 MAR FORM
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2021-00289 Parcel# 51 901-5 0-0 2907
Applicant Name Debbie Hatercamp Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 754 LOST LAKE. BLK 2, LOT t i
City State Zip TENINO.WA98589-0754 Installer Name MANKE EXCAVATING LLC
Site Address 811 W LAKESIDE DR,SHELTON Designer Name Jim Zimny
INSTALLATION CHECKLIST
111 Full System Installation ❑Tankls)Only ❑ Drainheld Only 0 Repair ['Other
System Type PUMP TO GRAVITY Pretreatment Type
>5 ft from foundation? - 0 N/A •YES 0 NO
>50 ft.from wells? - - ❑ e 0
2 -50 A.from surface water? - " - - ❑ III
eff C Cleanout between building and tank? ❑ III
U Tank baffles present? - - 0 . 0
I— 24"access risers over each compartment?- - 0 ® ❑
W Effluent filter installed?- - 0 MI ❑
In
Septic tank capacity (working) 1200 gal Manufacturer HAGERMAN
O D-box water level and speed levelers used? - - ❑ NIA ®YE8 ❑ No
pJ
0 Manifold/D-box accessible from surface?- - El III '. ❑
mall Check valves installed? - - 0 ■ 0
OQ 2 Transport Line Size 2" Schedule/Class SCH 40
Bedrooms Installed (check one) 0 2 ®3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft from foundation? -lhtF -- ■ rA 1)(Es ❑ NO
• >100 ft. from wells?- 1/i -"?' - ■ ® 0
W >100 ft. from surface water" - 4r ^1® : 0 ® 0
ii �❑ 5 0
LL >to ft. from potable water lines? c A� u
QZ > 5 ft. from property lines and easements?- - - • lII . . ❑
K > 30 ft from downgradient curtain/foundation drains? -- - - I. f- M 0
ra
Drainfieki level and observation ports present - - ❑ ® ❑
NI Graveless chambers or 0 Clean gravel used' (check one)
Proper cover installed over drainfield? ❑ ® 0
Pump tank setbacks consistent with septic tank? 0 N/A ® YEs 0 NO
Y Pump tank capacity(flood) 1200 gal Manufacturer
< 24"access riser(s)and accessible from surface? - ❑ II 0
a Alann or Control Panel Installed? - 0 5 ❑
f Control Panel equipped with Timer!ETM I Counter- 0 ® 0
M
d Pump installed in ❑ Bucket or ® On Block or 0 Other
a'• Pump Make/Model LIBERTY 280 ®Floats or 0 Transducer
7
0_
a Tank draw down 3 in/min Pump capacity 60 gpm Squirt Height N/A ft
Pump on time 45 SEC Pump off time 4 HISS Daily flow set at 270 gpd
Meson Chi OSS Insteftetion Report p9. 2
Parcels 6(-' '-6
0rEsao
were*mime wont Ca+maente d a as Pa rift agd e '
Myer. Pieeee describer __---- YES ID
allc components Pranced Ma and abandoned per WACZM&212X0300_
NO
.. - R*MY eat"." rk.c 1 c
n...MIST ale pr.rrrrawndwe 5 aNM+waMwn�4 * tow new. ar+,www.we M.+... ....a+.
MIST wM�+Gs* eveSte.nwb L.etibelW.Mmvaw.nw...n..seem e+..a90 Vwm=uMm ^0' .-� iVme--"^f
I M.m�w.mP.'.�MrwW.wNlf�lY.w'a.w.>!w(K4N libel xro�o.r+P9we nw.'A m.r'�..M NSW.�Y+wt.^"•" 1.,..,.
gltec"d ptaveng Adtadte0
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CERTIFICATION OF INSTALLATION
DESIGNER/ENGINEER
I cnt*POSTAL/ER I certify that the system has been mailed m acea"-
t e sera desert
the system WI ED 'by MasonnCe with PPRC VED b'y
WW1-
the sePticC desgml stamped`APPROVED"by dance with the 9ephc demon stamped�1
County Pubic Neagh and that any deviations shown Mason County Pubic Health and tnat.any hernaboos
both
here have been by both Mee designer shown here have been cleared/approved by
and Masan County Public Meat and meet all State myself and Mason County PUDt Hear and,,.,.meet all
and Math Cony Codes. State and Masan County ty Codes �.,,
on tNs I further certify that all artormadon co nedon Mrs
Jgflt and Moaned
,edtha ail odd Dawi contained tone and attached Record Dnawer9,s IL"',.-,_."rye'..
+vrda+rared Record Drawing it acCudaM.
tioltaitlitirad .r.44 42-- 7-a
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