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Home My WebLink AboutSWG2021-00644 - SWG As-Built - 11/17/2023 Mason County OSS Installation Report pg. 1 w ,MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00644 Parcel # 22128-76-90074 Applicant Name SHANTEL BARTELL Subdivlslor: (Name/DW/Block/L Pt) Applicant Address 491 E PROBERT ROAD City, State, Zip SHELTON, WA 965Ua i Installer Name nr �,,. L �,� 7 L` Site Address SAME Designer Name CINDY WAITE INSTALLATION CHECKLIST NI Full System Installation ❑Tank(s)On y ❑ Dray',el()a,,v I I Repair [] owes System Type__- PRESSURE DIST P -- "-- ---_�rer catme- Type _-_- >5 H. from foundation? >50 ft from wells? _ 0 N/A g YES E] NO Z >50 ft. from surface water? . L, ❑ F Cleanout between building and tank ---- U Tank baffles present? - -. - _ .. _ - _ ,1 a24" access risers over each compartment? .. - ] S0 N ILI Effluent filter installed?. - - .. _ _ - _ _ L Septic tank size 1 ! 2.50 77 L7El -__gal Manufacturer _ut<.c,Lrvv`c c\ 0 D-box water level and speed levelers used? - - - _ OLL Manifold/D-box accessible from surface? G NrA L.: YES Li No mOQ Check valves installed? - - . _ . _ - _ 0 II ❑ g TransportLine Size IJ ❑ r] 2 Scheduler Class SCHFDUIE 40 Bedrooms installed (check one) [1 2 Li 3 [14 >10 ft fromfoundaton? D ' 1 �e r�� Commeraal/Other 0 ',ID()ft from We115?- _ -. uN'A © YES ❑ NO J >100 ft from surface water? - - Li Li ❑ LWu. --IC ft from potable water lines? - L 0Eii • > 5 ft from property lines and easements> - G I-1 > 30 ft. from downgradient curtain/foundation opal^�:.> - _ I� L_ Dram portsF field level and observation re esen: - _ @I rJ ( 1 - ® Graveless chambers or El Clean gravel used: (check ane) ❑ Proper cover installed over drainfield? _ !J • El Pump tank setbacks consistent with septic tam0 - Y Pump tank size I Z$'� I J N/A . YES I J O N Z —_9al Manu(e !net L�d^w.G,n - F24"access nserjs)and acces;able from sadace'� - - _ _ - - - -- -- - r, a.)(Alarm or Control Panel Installed/ [_I 2vv Control Panel equipped with Timer 1 ETM/Coumer - ' 1 D 0 a (Pump installed in ` 43 l J ❑ Bucket or 0 On HIOCK or I ! r 2:Pump Make/Model i i G c -�G(} - — ��a 1 - r of F.] T,mini J Pr CL. :Tank draw down Wmin Hump r-apaoiv _ 3n,urt Herd^.t , Pump on time " __- Pump PITfire Dairytlov 'elat gp; C, nie . / Pont / �r / e/eJ<;, lti till / 'ri/'l -j� zs Mason County OSS Installation Report pg. 2 Parcel it 22128-76-90074 ABANDONMENT RECORD Were existing septic Components abandoned as part of his project' If yes, please describe' ❑ YES Q NO Were all components pumped out and pro - _- -----G party abandoned per lJAC�46>rtA IJ}Bpi ❑ YES Q NO RECORD DRAWING MS Is s permanent rscord end must be acetate and descriptive enough In re-locale Ir the need of malnteNnfe achwues and louse development. rvpiwl Record D.awingSStale! Galllield&manifold or'nlsum18lark Septidycarry lam IrclllglIart.Vow reosso drerred ovlellrg and proposes rurld,gs Swann of wens w wellx obeMvglon bats.dea/ods.at other Malmenance yyy pantslwnweeF J ,. rigs inns _ ado box al dell final as-Watson a ..al ndelptedern r r sermon —___.,._` A 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 cleareciapproved 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 cattily that all information contained on this I f er certify edt all iordrDahon is contained to this form a d ftache�ecord Drawing is accurate form and attached Record Drawing is accurate _ II-I Si attire of Meta:4� Date tail; tJ,lllaws &rl C Cre3oi e Printed Name of Signee P f .r a 0. MASON COUNTY PUBLIC HEALTH 3 �' - VP Elf 1/ The undersigned approves this Installation Report and &) 1 to \. , it Record Drawing on behalf of Mason County Public .GJ t"'END6G oFsi Toiren ; Health: y�. I t r N • y EXPIRES USIAJ" I I I )/ ' i 1Z� Signature of Environmental Health Specialist Date yV.\ (s:amP, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON HE MASON COI INTY WEB SITE tmialm.aemele ' Xr j /a ' zo, I f 10 1 i I i f I I --r !-- I 1 i 1 C4 r� LLL 01 X r.�e rro - ^I, tok tabli x7' :A s+awi 4rr , \ -7p2I v � , 1 r^L IKg ODES ER lI 1 [VIALS 05,I0 %%%%, -PIU Ce lie/ i5 L{:, [Nihp Q.D /o }��W; Iv 1. ,e PRoUr-,} Rd ( " - .. /2 - 74 '007Y i-t4I Pit.bid ✓",-: IA?' I C-1•- j I I I1 l.- I ''‘P i. JI 0 PA,po .ii �� I - t � .Yo :Lao � LCcJ i 1 ii Cu ivoeyif --tank • r�P �9 I1 ��,lA 0 11u0 <(d '76w f` �` arey 1(J, Y h1t 1 ,\c�1 CO.�c'it Atr'�i .rry n<J. Y e As lI NEED DESIGNER 1 I nfl .. ' i qw ,1 ;{ 0.4 11 TlaJ clp0L F R.l. .y. COiligUer & cern 6) -a P1 %+Ju} t. . 6) s/acwr fiu. l..l. 4, `/ y N Gip) -rM, P041 "I" /1) r e4k}y r wa}or_sjrfr•- NOV 17 � ._. -- 2fi"3 3o ' I Lay , Go ' o L l ff = 3u '