HomeMy WebLinkAboutSWG2024-00083 - SWG As-Built Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00083 Parcel # 220175200085
Applicant Name John Peppers Subdivision (Name/Div/Block/Lot)
Applicant Address 701 E Lakeshore Dr E Timberlakes/ 101101185
City, State, Zip Shelton.We 98584 Installer Name Logan Spear
Site Address same as above Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation N Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pressure Pretreatment Type
>5ft.from foundation? -- -------------- ---- -- -- --- I❑ NIA 0 YES ❑ NO
>50 ft.from wells? ---------------
Z >50ft.from surface wateR ---------- 11}-=-'- - - - - - -- El
� El
It
rCleanout between building and tank? ----- - - -,.•r - - -- ❑ ® ❑
U Tank baffles present? --------------,L- - ------- --- -
❑ ❑
a24"access risers over each compartment?---'�- - - - - - [l] ❑
W Effluent filter installed?--------------+-- - - �---- - - ❑ ❑
M
Septic tank capacity(working) 1200 gal Manufacturer Roth
o D-box water level and speed levelers used? - -- -- -- - e NIA ❑YES ❑ NO
DO Manifold/D-box accessible from surface?-- -- -- -- -- ---- -- - e ❑ ❑
p?Z Check valves installed? - - - - - - - - - - - - - - - - - - -- - - ---- ❑ ❑
OQ
I Transport Line Size PcheduletClass
Bedrooms installed(check one) ❑ 2 3 ❑4 ❑ 5 ❑6 ❑CommerciallOther
>1 Oft.from foundation?- --------- _ _____ ______ __ 0WA ❑ YES El NO
0 >100ft.from wells?-- --------- ------ -- -- -- ---- -- ❑ ❑
W >100 ft.from surface water? -- -- -- ---- -- -- -- -- -- -- - - ❑ El
LL >10ft.from potable water lines?----- ----- -- - - -- -- -- - - ❑ ❑
Z >5 ft.from property lines and easements?- - -- - - - - - - - - - - -- e ❑ ❑
>30 ft.from downgradient curtain/foundation drains?- - - - - - - - - - e ❑ ❑
0
Drainfield level and observation ports present -- --- --- -- - --- ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?-- -- -- -- -- ------ --- E ❑ ❑
Pump tank setbacks consistent with septic tank?------------ - E NIA ❑ YES ❑ NO
Y Pump tank capacity(flood) at Manufacturer
Q24"access riser(s)and accessible from surface?----- -- -- -- -- ■ ❑ ❑
F-
y Alarm or Control Panel Installed? --- -- -- ---- -- -- -- -- - - ❑ ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - e ❑ ❑
d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a Pump Make/Model ❑ Floats or ❑ Transducer
2
Tank draw down in/min Pump capacity pin Squirt Height ft
a
Pump on time Pump off time Daily flow set at gpd
upa.r Winols
ra Mason County OSS Installation Report pg. 2 Panel# 220175200085
ABANDONMENT RECORD
Were existing septic components abandoned as pan of this project? --- - - - - - - - - - - -- Q YES ❑ NO
If yes, please describe:Dud out and disposed of/backfilled with pea Gravel
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - -- - - -- Q YES NO
RECORD DRAWING
This to a pemun.m record and must de a«ume and tlewrndive arouyn as Meuh In M.hand of melnlahanha isitsmha and Islands aarebgnwM1 Twirai Re2rd
D2xMpa cortlaln: DrelnfieM a handed wianlsaon a layout,sepYUpump AnF lexalbn.Noun anaw,reserve Oalnrield,adding and pmpoxd bulmegn.Wa sin olwells,wsbdmes.
weus. vatnn pvls.dmroub.eM ONar mainlerervc auaae gmnls. finmmdeb WxN Drawings may creels addNonal delays in final lnamlblun appre`aal add rele4d parhils.
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® 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
formI and attached Record Drawing is accurate. form and attached Record Crewing is accurate.
3115124
Signal re of Inst filed r Date
Loden Spear
Printed Name of Sign"
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
31� Iz�
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAIIABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upeaW a2vzate
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