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HomeMy WebLinkAboutSWG2020-00614 - SWG As-Built - 4/12/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00614 Parcel # 42127-13-00010 Applicant Name SteveChiappino Subdivision (Name/Div/Block/Lot) Applicant Address 301E Walace Kneeland Blvd #224 City, State, Zip Shelton, WA 98584 Installer Name House Brothers Site Address 950 W California Rd. Shelton Designer Name Frank Marcinko INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only El Repair ❑ Other System Type 1'-`\ t-ti, Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES El NO >50 ft. from wells? - - ❑ 0 ❑ Z >50 ft. from surface water? - - ❑ 0 CI • Cleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - - ❑ ® ❑ a24" access risers over each compartment?- - CI X ❑ W Effluent filter installed?- - ❑ ® ❑ N Septic tank capacity (working) 1 250 gal Manufacturer House Brothers Const Inc 0 D-box water level and speed levelers used? - - ❑ N/A I YES ❑ NO 0O Manifold/D-box accessible from surface?- - CI 0 CI 00Z Check valves installed? - - 0 ❑ ❑ c)Q 2 Transport Line Size 4 Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑� 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A IMI YES ❑ NO O >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - CI 0 CI u. >10 ft. from potable water lines?- - ❑ © ❑ Z > 5 ft. from property lines and easements?- - ❑ NI CI ii > 30 ft. from downgradient curtain/foundation drains? - - ® ❑ ❑ CI Drainfield level and observation ports present - - ❑ • ❑ O Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - ® N/A ❑ YES ❑ NO W c • Pump tank capacity (flood) gal Manufacturer 3 < 24" access riser(s)and accessible from surface?- - ❑ ❑ ❑ H a Alarm or Control Panel Installed? - - ❑ ❑ ❑ c� 2 Control Panel equipped with Timer/ ETM / Counter- - ❑ ❑ ❑ r. M c a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other iN EPump Make/Model ❑ Floats or ❑ Transducer C a. Tank draw down in/min Pumpcapacity gpm Squirt Height a P Y ft q Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 `Mason County OSS Installation Report pg. 2 Parcel# 42127-13-00010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project'? - - 0 YES NO If yes. please describe: Were all components pumped out and property 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' nrainfiaid R manifold onentation P.layout.cootie/pump tank location.North arrow,ration",drninfiold,oxisiinp and proposed i oldingo.location of wall*,waiorlinos, wells.observation ports.cloanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. A PPROVE APR 12 2022 VASON COUNTY ENVIRONMENTAL HEALTF' NiEtW 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 Count Public Health and meet all State myself and Mason County Public Health and meet all and Mason Coun Codes. State and Mason County Codes I further certify tha all information contained on this I further certify that all information contained on this form and attach ecord Drawing is accurate. form and attached Record Drawing is accurate. W/ d>02- Signature lnstallb Date i I i t tt, of Printed Name of Signee �1�� t / /•.� fw // vI/ MASON COUNTY PUBLIC HEALTH ,,l"I.,r� �►, The undersigned approves this Installation Report and ��� '�) Record Drawing on behalf of Mason County Public i 20100609 I Heal a FrwkA.Matdnko 11 LICENSED DESIGNER i(/ve.9) ---,) �r�',r�y^ 4 6/S .ZAL Sig atur nvironmental Health Specialist Date (stamp. signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated a21no1e MI CD A m 0 V1 O N N N Z0 F+ NJ....1 3 0 mini O N 41 1 O O 0 • (0 Y/ • a C 4-60' ROW -> t - d' �'�;� 0 be, r 41 • / 6)-• n r a • _,. ..,.0 • • leo \, c� • • CP , • • • \ • • •. i'D n m a io rig = m C w :x no n • � m c i;o itII •C = 3 i`0 `CD m G 0 n) N 1 z := Slope>15% -- n �o, fD iy iQ if a. a s a_ co z Q� + L•7 A i i W [./7 sum 0l i= o a 3 AIJ Q [9 V1 F m 7 :(D -1:2 ro CD COn• d u3 n01 •0 • • Cti gr LC ET •� 1 C CJ1 'II p (D a g N Q. n c = %� i ' ti `= cD 11 mo - `PN ' ' CA O � =- N oC [0 N r M• aCiW G x . 3 S... oc til4 o +Q • 0_ = Cu O rD ON = rim n fD C fD %\\\ 0 D < I? / \\ • \\�� fi O , i 11 %\ N O — t•N % rt Qp $ I1fl 0- N 4. ; g .. „....... ,2:1. ..... _ ,, , 27 400... n m 0 - �z 012 N CO 3 Pre CD O Cl. 1 Z � x Z nri rn