HomeMy WebLinkAboutSWG2023-00151 - SWG As-Built - 4/2/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00151 Parcel# 42025-75-00090
Applicant Name Jose Mendoza Lopez Subdivision (Name/Div/Block/Lot)
Applicant Address 40 E Rhododendron PI
City, State, Zip Shelton WA 98584 Installer Name Maples Excaya6ng
Site Address xXX W Wynevood Dr Shelton Designer Name Arrow Septic Designs Inc
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfieltl Only ❑Repair ❑Other class a waiver
System Type Shallow Pressure Trench Pretreatment Type 50'Attenuadon Zone
>5ft.from foundation? -- - --- -- - -- �1551' t T,-IJ_� El NIA ®yes ❑❑ NO
>50 ft.from wells? -- ---- -- ----- JJ IS
z >50ft.fromsurfacewater? - - ------ �pgZS2D�4 ❑ ® ❑
Cleanout between building and tank? --- ---------- - - ❑ ® ❑
U Tank baffles present? -- - - -- - --- - --- --- -------- ❑ ® ❑
I 24"access risers over each compartment? B ❑ ® ❑
W Effluent filter installed?- - --- ------ - -- - - - -- - - ---- - ❑ ® ❑
in
Septic tank capacity(working) 1 530 gal Manufacturer Infiltrator
0 D-box water level and speed levelers used? ----- ------- -- - ❑ NIA ❑ YES NO
0o Manifold/D-box accessible from surface?- - - -- --------- - - - ❑ ❑
rdZ Check valves installed? - - ---- - - ---- - - - - - - ❑ ® ❑
O¢
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed(check one) ❑ 2 ❑3 ❑4 ® 5 ❑6 ❑CommerciaVOther
>10ft.from foundation?-- - - - - - ---- - ------ ❑ wA ® YES El No
I] >100 ft.from wells?---- ---- - --------- --- ---- -- - - ❑ ® ❑
W >100 ft.from surface water?----- -- - ------- ---- - -- - - ❑ ❑� El
M >10ft,from potable water lines?- -- - - ------- - ---- - - --- ❑ (] ❑
Z >5ft.from property lines and easements?--- --- -- -------- ❑ ❑� ❑
a
K >30 ft.from downgradient curtain/foundation drains?-- - - - - - - - - ❑ ❑
Drainfieltl level and observation ports present - - -- - ---- ----- ❑ ® ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over dreinfleld?--- - - - ---- - - -- ----- ❑ (] ❑
Pump tank setbacks consistent with septic tank?-- - ---- --- - -- ❑ NIA ® YES ❑ No
`L Pump tank capacity(flood) 1,787 gal Manufacturer Infiltrator
Q24"access riser(s) and accessible from surface?--- ------ - --- ❑ ® ❑
~ Alan or Control Panel Installed? - - - ----- ------------- ❑ PE ❑
a
� Control Panel equipped with Timer/E7M/Counter-- - - - - ----- ❑ � ❑
7
a Pump installed in ❑ Bucket or e On Block or ❑ Other
a Pump MakeWodel Zoaller N152 ® Floats or ❑ Transducer
0 Tank draw down 1.5 in/min Pump capacity 53 gpm Squirt Height 5.5 ft
a
Pump on time 2.8 min Pump off time 6 hr Daily flow set at 600 gpd
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Mason County OSS Installation Report pg. 2
Parcel# -oZS - -(S- 000410
ASANDONMENTRECORD
Were existing septic components abandoned as part of this project? . -_ - - - ___"____ . ❑ YES NO
If yes, please describe:
Were all components pumped out and propedy abandoned per WAC246-272A-p300? -'--"--- ❑ YES ❑ NO
RECORD DRAWING
nia 4 a pennarant mod and nom M aotume an d—rPv-enau9a no reiocau in Ne need o1 m ionno.oN ctivitias and NM1Ire Ewelopnmt Typo)R.-
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aMa,..on pdsa,GmaGs,and oI tan's. InmmpMb Record 02vnnga may orb oPIN-nal days in final IktlJNon gpmvW—2klm Fennrts.
® 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 clearedlapproved by both the designer shown here have been clearedlapproved 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate.
ul
�Signatum of Installer Date
Printed Name of Signee as tia
Y (i
MASON COUNTY PUBLIC HEALTH tN`!+
x
The undersigned approves this Installation Report and
muaeg
Record Drawing on behalf of Mason County Public PA LA JOY JOHNSON
Health: l:tll)ESIGNER N
Signature of Environmental H alth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEE SITE oseam erz'rzme
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Cleanout
1500 Gallon Septic Tank
2-Compartment with
Effluent Filter
1 O 15 90 Gallon Pump Chambe
A W ant s�iF1,on
40'Y50' Q/ O Valve Control Box
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PA to JOY JOHNSON
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