HomeMy WebLinkAboutSWG2021-00187 - SWG As-Built - 4/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2 v -7 /_ito i S7 Parcel# 320 1-56-02027
Applicant Name ROBERTSTEWART Subdivision ( me/Div/Block/L
Applicant Address 550 E WOOD LANE R
City, State, Zip SHELTON,WA 98584 Installer Name SCHOENING EXCAV LC
Site Address 650 E WOOD LANE Designer Name CINDY WAITE
INSTALLATION CHECKLIS
K Full System Installation ❑Tank(s)Only ❑ Drainfielo Only ❑ I epair ❑Other
System Type PRESSURE DIST Pretrea rent Type
>5 ft. from foundation? ------ ------- -- QNIA ❑YES NO
>50 ft.from wells? --- -------- - - - - - - ® ❑ ❑
Z >50ft. from surface water? - - - ------ - - - - - - - - - - - -- -- ❑ Q ❑
Cleanout between building and tank? - - -- ® ❑ ❑
U Tank baffles present? ----- --- -- - - -- - - -. - - - - - - ---- ❑ 0 ❑
a24"access risers over each compartment?-- - - - - - - - - - - -- -- Q K ❑
rW Effluent filter installed?- -- ---- --- - - - - - - - - - - - - - -- -- ❑ ❑
Septic tank size 1250 gal Manufacturer HAGERMAN
o D-box water level and speed levelers used? -- - - - - - - - - - ---- WA ❑ YES ❑ No
00 Manifold/D-box accessible from surface?- -- - - ® ❑
oQCheck valves installed? - --- - ----------- -------- -- ❑ ff El
N Transport Line Size 2 Schedule/Class S EDULE 40
I
Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑ 5 ❑e ❑CommerciaYOther
>10ft.from foundation?---- ------------ - --- ---- -- ® NIA ❑ YES ❑ NO
0 >100 ft. from wells?- -- -- -- ---------------------- ® ❑ ❑
W >100 ft. from surface wateR -------------- ------- --- ❑ ® ❑
LL >10 ft. from potable water lines?------ --- ® ❑ ❑
Q > 5ft. from property lines and easements?- --- - - ----- ----- ❑ ❑
R > 30 ft.from downgradient curtain/foundation drains?-------- -- ❑ ❑
Drainfield level and observation ports present - - - - - ❑ ff ❑
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfeld? ---- ❑ o ❑
Pump tank setbacks consistent with septic tank?--- - --------- ❑ NIA 0 YES ❑ NO
Y Pump tank size 1250 at Manufacturer HAGERMAN
Q24" access riser(s)and accessible from surface?- ----------- - ❑ ® ❑
aAlarm or Control Panel Installed? -- -- --- --- -- ---- -- -- - ❑ ❑ �\7,
Control Panel equipped with Timer/ETM/Counter- --- - - - -- - - ❑ ❑ J
c- Pump installed in ❑ Bucket or ® On Block or ❑ Other
a Pump Make/Model LIBERTY 290 Floats or ® Transducer
:3 Tank draw down 2 intmin Pump capacity 46 gp i Squirt Height 4 ft
a
Pump on time 1 Pump off time 8 Daily flow set at 180 gpd
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Mason County OSS Installation Report pg. 2 Parcel n 32021-56-02027
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -- - - - - - YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246272A-0300 ---- - - -- ❑ YES 0 NO
RECORD DRAWING
This lea palmanent ral and moat Ee accurate and deal enough to m locale In Ne need or main,,11iimnce acuvluee ana futon dwelopment Typical Rwo,d
omvings contain DninrnldBm rsotl cranialpn8layaul,SeptkJpump lank location.When artow,reeerredmin(lel existingend pmpoaed Euiltlings,location 0 wells,wateninas,
walls ObMNMimp .0MnpYa,"mwmaYitena1 aGnpdne, IIWlliplala ftesrC plBwing6may u9eba dilbnal del6ya InMBI In91e116110n eppmval and re1a180 permits.
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI E QINEER
I Certify that I installed the system in accordance with I certify that the ystem has been installed in accor-
the septic design stamped APPROVED"by Mason dance with the optic design stamped"APPROVED"by
County Public Health and that any deviations shown Mason County ublic Health and that any deviations
here have been cleareWapproved by both the designer shown here ha been clearsdopproved by both
and Mason County Public Health and most all State myself and Me n County Public Health and meet all
and Mason County Codes. State and Maw County Codes
I further certify that all information contained on this I further certify t at all information contained on this
form and attached Record Drawing is accurate. form and attach Record Drawing is accurate.
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Signature of Installer Date
Pdnte dN meof Sign
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MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and LICE SE"`D DESIGNER
Record Drawing on behatt of Mason County Public expwbs osllu ll
Health:
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Signature of Environmental Health Specialist Date ( pmp,signature and date)
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