HomeMy WebLinkAboutSWG2023-00296 - SWG As-Built - 10/4/2023 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00296 _ Parcel # 12030-75-90132
Applicant Name HOPTOWIT AND SCHEMER .Subdivision (Name/Div/Block/Lot)
Applicant Address 80 E FERRY LOOP RD
City. State, Zip SHELTON WA. 98584
Installer Name SELF INSTALL.
Site Address 60 E TAMARACK LANE
Designer Name CINDY WAITE
INSTALLATION CHECKLIST
t Full System Installation ❑Tank(s) Only ❑ Draintield Only ❑ Repair ❑ Other
System Type GRAVITY
--___ Pretreatment Type___
>5 ft. from foundation? -
>50 ft from wells? - - _ _ _ _ _ _ _ ❑� N/A ❑ YES El NO
❑
Y >50 ft. from surface water? - - - DI_ _ _ ❑ ElFQ- Cleanout between building and tank? - - El
U Tank baffles present? - - ❑ • ❑
E El ID
It 24"access risers over each compartment? - - _ _ _
W Effluent flier installed?- - - _ _ _ El ❑
co
Septic tank size 1250 gal Manufacturer
__ _-_ HAGERMAN
,� 0-box water level and speed levelers used?
'NO Manifold/D-box accessible from surface?- - - _ El N/A YES ❑ No
i Check valves installed? _ _ _ _ _ - _ _ _ - - - - - ❑ 0 El
Q Er El
Transport Line Size 4
Schedule/Class__r 3034__
Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5
>10 ft. from foundation? - ❑6 ❑Commercial/Other
- - _ - O N/A ❑ YES ❑ NO
>100 ft. from wells?-
>100 ft. from surface ill W .,e water? - -. - _ _ _ El ❑
LL >1 0 ft. from potable water lines? ❑ El
Z > 5 ft. from property lines and easements?- - - - El ❑ ❑
a ❑ X ❑
te > 30 ft. from downgradient curtain/foundaton drains? - - _. . _ _ _ ❑
Drainfield level and observation ports present - ❑ ❑
❑ Graveless chambers or pi Clean gravel used? (check ones ❑ IS El
Proper cover installed over drainfield?
Ll o El
Pump tank setbacks consistant with septic tank-'
Z Pump tank size El N/A ❑ YES 0. NO
gal Manufacturer
Q 24" access riser(s) and accessible from surface?
y Alarm or Control Panel Installed? - ❑ ❑ ❑
❑ ❑
Control Panel equipped wth Timer/ ETM /Counter- - - _ ❑
❑ ❑ ❑ !
R Pump installed in ❑ Bucket or On Block or ,\
a. ❑ ❑ Other_- _
f Pump Make/Model
---- - ❑ Floats or ❑ Transducer
d Talk draw down inimin Pump capacity _-_ 0pm Squirt Height ft
Pump on time Pump off time
- -- _ - Daily flow set at gpd
Mason County OSS Installation Report pg. 2 Parcel n 12030-75-90132
ABANDONMENT RECORD
Were existing septic components abandoned as part of this prolect7 - - - - -- _
If yet:, please describe
❑ YES ❑� NO
Were all components pumped out and properly abandoned per WAC246 272A-030(1) - - -
- - 0 YES 111 NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptivep enough'°-" I. . need ormaintenance aamproam future development
Drawingsr . Dd r' ma nlmd Dra t: sI . s_ I I a : ',mar ,tom
wellsbservaton ports t and c.ne a : rce access n Ito F .- Any am t slings _Is r„ar_ mus
.. r . I vemla� ,._e: r,r,.,���
0 Z CI C c 10"gJ lCZ .f=t/r:if6 /d Ad niacin/
V b I A J n i rairk /(N+/ 177 a veil -�-ZJ
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I Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER
DESIGNER/ ENGINEER
I certify that I installed the system in accordance with I codify 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 Pubic Health and tree(all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this
l fur7her atticfy that all iordrD awin((untamed accurate
to this
form and attached Record Drawing is acauate. loan and attached Record Drawing is accurate
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Signature of Installer Date 1
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Printed Name o/Signee - y's 04.l ; la
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MASON COUNTY PUBLIC HEALTH cjAi
2/3
The undersi red approves51Le WAI
9 this Installation Report and LICENSED DESIGNER ;ill
Record Drawing on behalf of Mason County Public
Health: .:w r�� �t,� ��% 01
9.13
Signature of Environment Health Specialist Date
(stamp signature and date)
THIS FORM MAY BE SCANNED AND AVAIL ABE F F OR PURL IP VIPVJ ON II qG MASON COUN IY WIF SITE I'-I,.
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OCi 04 2023
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