HomeMy WebLinkAboutSWG2023-00049 - SWG As-Built - 10/16/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00049 Parcel# 32127-52-00025
Applicant Name Erica Schuster-Rieffanauqh Subdivision (Name/Div/Block/Lot)
Applicant Address 2541 E St.Andrews Dr
I City, State, Zip Shelton,Wa 98584 Site Address 341 E Shamrock Dr Installer Name Active Underground LLC
Designer Name James Medcalf
INSTALLATION CHECKLIST
0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Oscar Pretreatment Type XO2
>5 ft. from foundation? - - ❑ N/A It YES ❑ NO
>50 ft. from wells? - ❑ II ❑
Z >50 ft. from surface water? - ' ❑_i t ® ❑
Q Cleanout between building and tank? ❑ 00 8 `7 ❑ ❑
U Tank baffles present? - g a zd2'i ❑ '[ Y ® ❑
H 24" access risers over each compartment?- - Q' N ❑
W Effluent filter installed?- :--a-- --- - ®I 0 0
co _ _-^ SPS
Septic tank capacity (working) 1200 gal Manufacturer -`
o D-box water level and speed levelers used? ® N/A ❑ YES ❑ NO
—IOLL Manifold/D-box accessible from surface? - ❑ PI ❑
a?Z Check valves installed? IN 0 ❑
GQ Transport Line Size 1" Schedule/Class 40
if
Bedrooms installed (check one) ❑ 2 513 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? ❑ N/A ® YES ❑ NO
O >100 ft. from wells? ❑ ® ❑
W >100 ft. from surface water? - ❑ ® ❑
E >10 ft. from potable water lines? ❑ ® ❑
Z > 5 ft. from property lines and easements?- - 0 ® ❑
co > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑
Cl
Drainfield level and observation ports present - - ❑ ® ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield? ❑ IN ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO
Y Pump tank capacity (flood) 1200 gal Manufacturer SPS
< 24" access riser(s)and accessible from surface?- 0 ® ❑
~a Alarm or Control Panel Installed? - ❑❑ t.k_rti O O
2 Control Panel equipped with Timer/ ETM/Counter- owe
r
0- Pump installed in ❑ Bucket or ❑ On Block or 0 Other PER X02
a
f Pump Make/Model X02 ® Floats or ElTransducer
a.a Tank draw down N/A in/min Pump capacity 8.8 qpm Squirt Height N/A ft
Pump on time PER Pump off time OSCAR Daily flow set at 270 gpd
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Mason County OSS Installation Report pg. 2 Parcel s 32127-52-00025
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - ❑ YES Q NO
If yes, please describe.
Were all components pumped out and properly abandoned per WAC246-272A-0300? - 0 YES 0 NO
RECORD DRAWING
This is a permanent record and must he accurate and descrWra enough to re-locate in the need of maintenance activities and future development Typical Reid
Drawings conlain: Dainfiele fl Mangold orientation&layout,septicipump tank location,North arrow,reserve drainfew,existing and proposed buildings,location M walls.wdmSnes,
welLs,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related pennkt
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0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
I certify that 1 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 that all_infoonation contained on this I further certify that all information contained on this
forma al;hed Reco - rawi- inaccurate. form and attached Record Drawing is accurate.
Sigia4d(e� nstaller Date Wit) ."11
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Me$ 1K-e AC G fC • 1�
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Printed Name of Signee }'
MASON COUNTY PUBLIC HEALTH t •
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The undersigned approves this Installation Report and y; '� �� re all
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Record Drawing on behalf of Mason County Public W. "... ;.�� "moat\wl,
Health: z , sr�
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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 erztrmts