Loading...
HomeMy WebLinkAboutSWG2021-00465 - SWG As-Built - 9/22/2022olumw Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00465 Parcel # 22017-21-01000 Applicant Name ALAN MACALEVY Subdivision (Name/Div/Block/Lot) Applicant Address 10 E JASMINE LANE City, State, Zip SHELTON, WA. 98584 Installer Name WORKMAN CONSTRUCTION Site Address 2-1.E JASMINE LANE Designer Name CINDY WAITE INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type `!\I//m Pretreatment Type >5 ft. from foundation? - ->50 ft. from wells? - TalEfili—i ❑ NSA YES ❑ No ❑ © ❑ >50 ft. from surface water? -z0 0 ❑ HCleanout between building and tank? - - - _ _ V Tank baffles present? - "� ❑ I ❑ I0. ` 24"access risers over each compartment?-- t - ❑ 0 ❑ W Effluent filter installed?- By - - ❑ Ill Septic tank size 1 . .)-0 gal Manufacturer AL / f'c�ryt N 0 O D-box water level and speed levelers used? - ❑ ❑ N/A IF YES NO 0O Manifold/D-box accessible from surface?- - 0 © 0 0 heck valves installed? - ❑ ❑ • Transport Line Size 4 Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO 0 >100 ft. from wells? - - ❑ ® ❑ J >100 ft. from surface water? - w ❑ ® ❑ Z >10 ft. from potable water lines?- - 0 ❑l ❑ Q > 5 ft. from property lines and easements?- - ❑ © ❑ Q > 30 ft. from downgradient curtain/foundation drains? - - PI ❑ ❑ Drainfield level and observation ports present - - 0 111 ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ® ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES II NO ZPump tank size gal Manufacturer < 24"access riser(s)and accessible from surface?- - ❑ 0 ❑ I— D. Alarm or Control Panel Installed? - - ❑ ❑ ❑ Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑ ❑ - Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a a• Pump Make/Model \\ ` ❑ Floats or ❑ Transducer d Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 22017-21-01000 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El 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,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Tod a if J a) pct. de.r hi, / �] 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 and attac ed Record Drawing is accurate. form and attached Record Drawing is accurate. 22- Z2^ Signature of Installer Date c1r r JAN n. tnrr► ao°41.sti • Printed Name of Signee 0 7A/ /1/ MASON COUNTY PUBLIC HEALTH �4� s //"� The undersigned approves this Installation Report and LICEN D DESIGNER Record Drawing on behalf of Mason County Public EXPRLS u5.10, Health: �2 mI mN1 a 1Z1 Signature of Environment)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 - E . rrr-,Aar h . . •,, 3 2t--Otopd F Ka r�S� ati � �IV, j 510G1 A.1•� rye i �V I/ CI YE • L �DCJ 1 U• 1 A3�/ o LICEN D Sir ER N 111 -- cx.P.RLS !SIC, 0 EY l f'i 1 Q!-f r..) .'".t.t c s 00 rI "�.0 0,,, `` .#- . ' . - e D .Q, . J ( _/ S S'o, /07 0- 32 $'(„ 21 s; <,At Daut, ,/A,€, I 0 S;" €/(. she.:CNo 6, d./J...r , l! S,,l 'o! 0 w / Qcam. 441►i„G 4 C4:3 4*?ifikSVLED 't C j Ei �14� 24 MASON COUW.E.NYj0�NMENTAI HEALTH 7 7'-..---(7 1.'.k..*....*......'.'..'''' 0 `RET (` C iN r 0 J 6 ,kr v , , io , 5. ._ AAat, ti.eui Prnnte . - z ... . t - e a _ a _ • a ► , a' Printed from Mason County UMS r D Ls,4.4.: 4.4.fi,4 .. • I) Rex l,,z i . __PI f I, .3 ''� --T- — ''rL --- ---- - .4-- Jr ._ .--. -_is' icji. !'4..., /0' 1 20 ,- 3U 1 r'1_ /0' A i 0 ohs. i-,,,,tio„) SEP 2 7 2Q21 \ 1, MASON C ;,I%F' 7'' ►j, Elf; : ` :44, a ~t �4 I it8 , rL' .4 41 1et v Y E. AITE 1 .,} ` (f LICENSED DESIGNER (1 " - ORI. ... ac.�.1>e �r 1.u1 _ -____ 2" D LA.„1- t1v Ov r goofs- /z4 p lii` i r" vrd,cd iy' ' ' 4op l3 -�1' a� i ,.)ilit tivw . i/,1• i . _._ <'q 7—#1.4.,..ej, G.-*SS 5:41.1krov tel\'-\ Printed From Mason County DMS Printed from Mason County ELMS