HomeMy WebLinkAboutSWG2023-00457 - SWG As-Built - 12/19/2023 0
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Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00457 Parcel # 220315000018
Applicant Name Kelly Crickmore Subdivision (Name/Div/Block/Lot)
Applicant Address 651 Souteast Totten Shores Dr
City, State, Zip Shelton, WA, 98584 Installer Name AAA Septic(Jake Pettit)
Site Address 651 Southest Totten Shores Dr Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation ®Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Pressure To Gravity Pretreatment Type
>5 ft.from foundation? - •- ❑ N/A III YES ❑ NO
>50 ft. from wells? - - 0 II 0
Z >50 ft.from surface water? - - ❑ MI
• Cleanout between building and tank? - - 0 II 0
U Tank baffles present? - - ❑ ® 0
d24"access risers over each compartment?- - ❑ IN ❑
tW Effluent filter installed?- - ❑ II
Septic tank capacity(working) 1250 gal Manufacturer NORWESCO
0 D-box water level and speed levelers used? - - ElN/A ElYES 0 NO
0O Manifold/D-box accessible from surface?- - ❑ ❑ 0
012 Check valves installed? - 0 NI 0
6‹
2 Transport Line Size 2": Schedule/Class SCH 40
Bedrooms installed (check one) ❑ 2 1 (3 0 4 ❑ 5 ❑6 0 Commercial/Other
>10 ft.from foundation?- - ❑ N/A ❑ YES ❑ NO
CI >100 ft.from wells?- - 0 0 0
W >100 ft.from surface water? - - 0 0 0
tE >10 ft.from potable water lines?- - 0 0 0
Z > 5 ft.from property lines and easements?- - 0 0 0
c2 > 30 ft.from downgradient curtain/foundation drains? - - 0 0 0
CI
Drainfield level and observation ports present - - ❑ 0 0
0 Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 0 0
Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO
• Pump tank capacity(flood) gal Manufacturer
< 24" access riser(s)and accessible from surface?- - 0 0 0
h-
a Alarm or Control Panel Installed? - - 0 0 0
2 Control Panel equipped with Timer/ ETM/Counter- - 0 0 0
M
n- Pump installed in ❑ Bucket or 0 On Block or ❑ Other
a'• Pump Make/Model ❑ Floats or 0 Transducer
a.
a. Tank draw down in/min Pump capacity gpm Squirt Height ft
1 Pump on time Pump off time Daily flow set at gpd
Updated 821/2018
Mason County OSS Installation Report pg. 2 Parcel# 220315000018
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - El YES EI NO
If yes, please describe:We removed the existing fiber glass tank from site and installed a new tank in the same place
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES ■❑ 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 orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
wells,observation ports,cieanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
/
[i 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 certify that all information contained on this I further certify that all information contained on this
form.A00 ached Rec r ' g ' accurate. form and attached Record Drawing is accurate.
Awaifre- r 111-1123
Si.•'ure of Installer Date
Jake Pettit
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
0-Y\-12/VAI9(11,1 (2(I'f23
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 8/21/2018
Qtoler"'°5' Scale 1''= 50' "
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New 2 Compartment Norwesco 1250 gal APPROVED
septic tank low pro
a
DEC 19 2023
Decommissioned Tank Al MASON COUNTY ENVIRONMENTAL HEALTH
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Drain Field
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AAA SEPTIC
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Driv• Project Details
AAA Septic Decommissioned the
Existing septic tank, Replaced it
ouse with a new Norwesco 1,250 Gal
a 2 Compartment Septic tank with
P p Basin Risers to grade and a PL-122
Effluent filter installed in the
outlet baffle
40' 50' III ell
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