HomeMy WebLinkAboutSWG2022-00073 - SWG As-Built - 5/17/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SwG 2022-00073 Parcel# 31932.44-00090
Applicant Name Corey Morss Subdivision (Name/Div/Block/Lot)
Applicant Address 881 Partridge Dr NW
City, State, Zip Olympia, WA 98502 Installer Name Brandon Thompson
Site Address 1501M_ ' Designer Name Tony Godat
INSTALLATION CHECKLIST
3Z'FuN System Installation ❑Tank($)Only ❑ nranficld Only ❑Repair Other
System Type G I Cr\ DO� Pretreatment Type I V
15 ft.from foundation? - -- ❑N/A 2(1Es ❑ NO
>50 ft.from wells? - - - - -- --------- ----- -- -- ----- ❑ 9 ❑
W- >50 fL from surface"ter? -- - - ---------- ---------- ❑ X ❑
Cteanout between building and tank? -------------------- ❑ 9 ❑
0 Tank baffles present? - -- - -- - - -- -- --------------- ❑ of ❑
a24"access risers over each compartment?- ___ ___ __ ____ __. ❑ 2f ❑
LU N Effluent filter installed?- - - - - - - - -- - - - - - -- - - - - - - - - -- ❑ ❑
Septic tank capacity (working) 15? gal Manufacturer J:�'ue-rSrg¢ `-,
o D-box water level and speed levelers used? -- -- --- ---- -- -- [FwA ❑ YES ❑ NO
0O Maold/D-box accessible from surface?- - -- - -- ------- - -- ❑ ®' ❑
092 Check valves installed? - - -- - - - - - - - - - - - - - - - - - - - - - ❑ 51, ❑
Transport Line Size 7. 4 Schedule/Class
Bedrooms installed(check one) ❑2 ❑3 ®4 ❑ 5 ❑6 ❑Commercial/Other
>10ft. from foundation?--- ------- - -- - - - - - - - - - - - -- ❑ NIA (Y'ES El No
I >100 ft. from wells?--______________ _ {� pp. kv B�vr ❑
W >100 ft.from surface Water?- ------ --- - - -S- - -IS �If_ ® ❑
Z >10 ft.from potable water Ones?- - - -- -- - - - - APP '�-5-jp74 IT ❑
QZ >5 ft. from property fines and easements?- - - - C3 ❑
Q > 30 ft.from downgradient curtaintfoundaflon dra �- - - - - - - - - ❑ ® ❑
Drainfield level and observation ports present - - - - - - - - - ®" ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drain8eld?- - -- --- ----- -- - -- - - ❑ ® ❑
Pump tank setbacks consistent with septic tank?------------ - ❑ NIA agI YES ❑ NO
Y Pump tank capacity(flood) J:JOO at Manufacturer
24'access riser(.)and accessible from svrface?- ---- - - - -- - - ❑
MAlatmorControlPanelInstalled? - - - - - - -- - - -- - - -- - - - -- ❑ (a ❑
jControl Panel equipped with Timer/ETM/Counter- - - - - - - - - - ❑ ® ❑
IL Pump installed In ❑ Bucket or 5(On Block or ❑ Other
f Pump MekwModel GQU L�S MA E091 1 ❑ Floats or ❑Transducer
a Tank draw down in/min Pump capacity gpm Squirt Height ty T ft
Pump on time 1 Pump off time 10 Daily flow set at Ll O gpd
Jyep e]1/101B
Mason County OSS Installation Report pg. 2 Parcel a 31932-44-00090
ABANDONMENTRECORD
Were existing septic components abandoned as pan of this project? - -- -- - - - - - - - - - - YES NO
If yes, please describe.
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - -- - - - - WYES NO
RECORD DRAWING �S
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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 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
fomr and attac R ii hewing is accurate. J� form and attached Record Drawing is accurate.
l
Sign u Dam of Installer Date
Brandon Thompson
Printed Name of Sign"
<y Nmry�.
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and <
Record Drawing on behalfo/Mason County Public soma
Hearth:
MlhonY Npmen Godet'
k�-r�wM6�M S�Zl�
Slgnatu�E v nmente hh Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE u<wka a¢v¢me
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