HomeMy WebLinkAboutSWG2023-00409 - SWG As-Built - 4/25/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT]PERMIT INFORMATION
Permit Number SING 2023-00409 Parcel# 22001-51-00032
Applicant Name Lynn&Ken Thompson Subdivision (Name/Div/Block/Lot)
Applicant Address 751 E. McMickin Rd. Canyonwood Beach Lot 32
City, State, Zip Shelton,WA 98584 Installer Name T.J.Goos
Site Address 751 E. McMickin Rd. Designer Name Dale L.Tana
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other
System Type Pressure Trenches Pretreatment Type
>5 ft.from foundation? --- - - - --- --- --- - - -- --- -- --- ❑ NIA ■YES NO
:>50ft.from wells? -- ----------- - --------- ------- ❑ e ❑
>50 ft.from surface water? - -- - -- - - - -- ---- ---- -- -- - ❑ ® ❑
a
'�4 Cleanout between building and tank? - --- - -- - --,jam ❑ ❑
�.: Tank baffles present? - -- - - -- - - -- -- --- --eft-- - - - - -. ❑ . ❑
24"access risers over each compartment?--------- - ----- - ❑ B ❑
Ill- Effluent filter installed?- --------------- - ----- - -- - - ❑ ❑ ❑
N
Septic tank capacity(working) 1.250 gal Manufacturer Hagerman
C- D-box water level and speed levelers used? - - ------ --- --- - ® NIA ❑ YES ❑ No
J ❑ ® ❑
:Ou0. Manifold/D-box accessible from surface?----- - - ----- - - - - -
MZZ Check valves installed? -- -- -- -- - -- - - - - - - -- -- - -- -- ❑ ❑
,CQ�. Transport Line Size 2 inch Schedule/Class Sch.40
Bedrooms installed(check one) ❑ 2 E 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
-. >loft.(romfoundation?-- - - - - - - - - - - - - -- -- - --- -- -- ❑ NIA ■ YES NO
>100 ft.from wells?- - ------ - ------ ------- ------- ❑ ❑
.= >100 ft.from surface water? -- - - --- - - - -- ----- - ----- - ❑ ® ❑
'EL >10ft.from potable water lines?-------------------- - ❑ ® ❑
*' >Sft.from property lines and easements?-- --- -- --- ❑ ❑
,,.. >30 ft.from downgradient curtainBoundation drains?- -- --- -- - - ® ❑ ❑
GGG Drainfield level and observation ports present -- -- -- -- -- -- -- ❑ 0 ❑
Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfeld?----------------- -- ❑ ❑
Pump tank setbacks consistent with septic tank?--------- --- - ❑ NIA DYES E] NO
'. hl!: Pump tank capacity(flood) 1.000 at Manufacturer Hagerman
24"access nser(s)and accessible from surface?--- ---- -- - ❑ ❑
IL Alarm or Control Panel Installed? -- - -- ---- --- -- - -- - - - ❑ ❑
G ®
?.;,Control Panel equipped with Timer/ETM/Counter- -- -- -- -- -
❑ ❑
O.. Pump installed in ❑ Bucket or M On Block or ❑ Other
'.`IL;r.Pump MakelModel Liberty 280 E] Floats or 0 Transducer
IL
%:-Tank draw down 2 in/min Pump capacity 44 gpm Squirt Heigh 6 fl
Pump on time 3 min. Pump off time 5 hrs. 57 min. Daily flow set at 270 gpd
up]O.Brimu`
Mason County OSS Installation Report pg. 2
ABANDONMENT RECORD
Were existing septic components abandoned as part of this prowl? --------------- ❑ YES ® No
It yes. please describe:
Were all components pumped out and property abandoned per WAC24H-Z72A-03007 ------- ❑ YES ❑ NO
RECORD DRAWING
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® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I certify that I installed the system in accordance with I Certify that the system has been installed in acmr-
the septic design stamped APPROVED°by Mason deuce 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 clearad(approved by both the designer shown here have been dearedrapproved by both
and Meson County Public Health and meet all State myself and Mason County Public Health and meet all
and Meson County Codes. State and Mason County Codes
I further certify that all information contained W this 1 further certify that all information contained on this
form qnd attached Record Drawing 7s actIff9fe
r form and attached Record Drawing is accurate.
ignatore of Installer plate
Pdnfe�S/gyres � � n
MASON COUNTY PUBLIC HEALTH 3`
The undersigned approves this Installation Report and orb. $100214
Record Drawing on behalf of Mason County Public
liC- - D D SIGNER
Health:
Ory ' EXT'.:ray!
Signature of Environmental Verrill Spedailst Date (stamp,argnetum and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE wn�emaors
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