HomeMy WebLinkAboutSWG2024-00264 - SWG As-Built - 6/21/2024 RM-Mm
1 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00264 Parcel# 519085200229
Applicant Name Stolz Terri L8 Gregory B Subdivision (Name/Div/Slock/Lot)
Applicant Address 9035 Rainier Rd SE SW Lake B3 TR 229
City, Stale, Zip Olympia,WA. 98513 Installer Name Chris Lesman
Site Address 31 W Blakely Dr Designer Name Adam Hunter
- - INSTALLATION CHECKLIST : -
❑ Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
-1 System Type Gravity Pretreatment Type
>5 ft. from foundation? ❑ NIA ®vas ❑ No
>50 ft from wells? --- - - - - - - - - - - - ------ - -- ----- - ❑ ❑
X >50ft. from surface water? - - --- - - - - - - -- - - - - - - - - - - - ❑ ® ❑
r� Cleanout between building and tank? - -- -- - ❑ ® ❑
"E, Tank baffles present? -- - - - - - - - - - ❑ ❑
F 24"access risers over each compartment? - -- -- - ❑ IN ❑
ria
W Effluent filter installed?--- - - - - - --- - - - - --- - -- -- --- -
W Septic tank capacity (working) 1300 gal Manufacturer Premier
�1.0{ D-box water level and speed levelers used? - - - -- - - --- - --- ❑ NIA ❑ vas El NO
00I Manifold/D-box accessible from surface?- -- - - --- - - -- - - -- - ❑ ❑ ❑
mZ Check valves installetl? - - - - - - - - - - - - - - - - - - - - -- --- - El El El
C4
2 Transport Line Size Schedule/Class
-;� Bedrooms installed(check orii
2 ❑ 3 ❑4 ❑ 5 ❑6 ❑CommerciallOther
I>1Gft. from foundation?-- - - - - -- - - - - - - ---- - - -- - -- - ❑ NIA ❑ vas NO
-C3 100 R.from wells?- - - -- -- -- --- ---- ----- - - ----- - ❑ ❑ ❑
WJ ] >100 ft. from surface wateR --- - - - - -- - - - -- - -- -- - - -- - ❑ ❑ ❑
1`LL`.�I >10 ft. from potable water lines?--- - ----- --- - --- -- - - - - ❑ El El;Z { > 5ft. from property lines and easements?- -- ------- - - - - - - El El ❑
> 3D ft. from downgradient curtain/foundation drains?- - - - -- ❑ ❑ ❑
Grainfield level and observation ports present - - - -. - - - - - ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
'n `{ Proper cover installed over drainfield?-- -- -- --- --------- - ❑ ❑ ❑
` , - Pump tank setbacks consistent with septic tank?---- ---- ---- - ❑ NIA ❑ YES ❑ No
Pump tank capacity (flood) gal Manufacturer
¢'Q24"access risers)and accessible from surface?- -- -- ---- - - -- ❑ ❑ ❑
Alarm or Control Panel Installed? --- -- - ❑ ❑ ❑
Control Panel equipped with Timer/ ETM/Counter- - - - - -- -- - - ❑ ❑ ❑
Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
Pump Make/Model ❑ Floats or ❑ Transducer
..IL u. Tank draw down in/min Pumpeapacity, gpm Squirt Height ft
Pump on time Pump off time Daily Flow set It gpd
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Mason County OSS Installation Report pg. 2 Parcel u 519085200229
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - -- - --------- -- YES ❑ NO
If yes, please describe: Existing septic tank pumped out and abandoned.
Were all components Pumped out and property abandoned per WAC246-272A-0300? Q YES ❑ NO
RECORD DRAWING -
Tma is a pnmanent record and must Ee accurate and deseripure enough to n-locate in me need of mamWranca aeuernes and mwrt development Tpprrar Food
prawngaoarralm. oraullem6menAola dlemalbn6nyoul septldpumprank roeet.,r arm avow,league dRl,Wd,eanrroanM menusea bulldings, yommetwela,warMmes,
wel9,oueenavon pane,cleanoura and dtlRr mobtanance eceen pomb. meompkre kaomd Drumm,may ream addlvonal dakye F mal lnstaresm eppmval and related permits.
❑ 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 Me n Coun Codes. State and Mason County Codes
I fart dify all info anon contained on this 1 further certify that all information contained on this
for cc Drawing is accura . form and attached Record Drawing is accurate.
afore of n-tiller Dye
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Punted me of Signed
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and _ J
Record Drawingon behalfof Mason County Public ` "-1 r r l TaR
Health: 4r ttii� w s:r��s-
Signature of Environmental ealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upaaw arz+rzore
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