HomeMy WebLinkAboutSWG2023-00222 - SWG As-Built - 1/4/2024 .
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00222 Parcel # 421162300020
Applicant Name Tonia & Neal Deyette Subdivision (Name/Div/Block/Lot)
Applicant Address 8432 W Shelton Matlock Rd
City, State, Zip Shelton, WA, 98584 Installer Name Royal Flush w/glendon assistance Hatien &
Sons Landworks
Site Address 191 Deyette Lane Designer NameAdan Hunter-,lim Hunter and Assoc aites
INSTALLATION CHECKLIST
® Full System Installation El Tank(s)Only ❑ Drainfield Only ® Repair ❑Other
System Type Glendon Pretreatment Type
>5 ft.from foundation? - - ❑ N/A ®YES ❑ NO
>50 ft.from wells? - - El ® El
Z >50 ft. from surface water? - w_V_Mr4- 0
® ❑
< Cleanout between building and tank? - - - 4- ❑ ® ❑
UTank baffles present? - iAlilQ 2-' - -. El ® ❑
a24" ® CIaccess risers over each compartment?- - 0
W Effluent filter installed?- BY' - ❑ ® ❑
cn
Septic tank capacity (working) 1200 gal Manufacturer Sound Placment
9 D-box water level and speed levelers used? - - ® N/A El YES ❑ NO
DO Manifold/D-box accessible from surface?- - ® ❑ El
00 Z Check valves installed? - - ❑ ® 0
enQ
2 Transport Line Size 1" Schedule/Class Sch 40
Bedrooms installed (check one) El 2 ®3 El 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ® YES ❑ NO
O >100 ft.from wells? - - ❑ ® ❑
W >100 ft.from surface water? - - ❑ ® ❑
rE >10 ft.from potable water lines?- - ❑ ® ❑
Z > 5 ft.from property lines and easements?- - CI El
12 > 30 ft.from downgradient curtain/foundation drains? - - ❑ ® 0
• Drainfield level and observation ports present - - ❑ ® ❑
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - - Cl N/A ® YES El NO
• Pump tank capacity (flood) 1275 gal Manufacturer Sound Placement
Q 24"access riser(s)and accessible from surface?- - ❑ ® ❑
H
EL Alarm or Control Panel Installed? - - ❑ El ❑
E Control Panel equipped with Timer/ETM / Counter- - Cl ® ❑
m
a Pump installed in ❑ Bucket or ® On Block or ❑ Other
2 Pump Make/Model Liberty FL31 M ❑ Floats or ® Transducer
M Tank draw down 1/2 in/min Pump capacity 11 gpm Squirt Height N-n ft
a
Pump on time 14 seconds Pump off time 13 min 6 sec Daily flow set at 270 gpd
Updated 8/21/2018
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Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ® YES El NO
If yes, please describe: Old septic tank pumped out and filled with native soil
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ® YES 0 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: Drainfield&manifold onentation&layout,Sephcpump tank location,North arrow,reserve drainfietd,existing and proposed buildings.location of wells,waterlines,
wells,observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may creale additional delays in final installation approval and related permits.
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Asf'fz;� � �5 tG
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 gertify that all information contained on this I further certify that all information contained on this
form a ' tt Record Drawing is accurate. form and attached Record Drawing is accurate.
/ Z-1s2i 77.
Sig Lure Installer Date^ 61; -
77 ,:,- -•:.,. „„(.4,3
Printed Name of Signee t ;,
MASON COUNTY PUBLIC HEALTH w.
- S1JW 12
The undersigned approves this Installation Report and �® �': AOAr:1 J.HUNTER
•'�,
Record Drawing on behalf of Mason County Public `1'ti 1`�S'•i;^JtA."
Health: Mqso '4/y Q �:.:. y
//c/( ZU Z NCOUNryFN�R 2O?�
Signature of Environmental Health Specialist Date �'A FNTgf 74 (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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