HomeMy WebLinkAboutSWG2021-00598 - SWG As-Built - 6/6/2024 ��
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021-00598 Parcel # 220362400020
Applicant Name Joe strmm Subdivision (Name/Div/Block/Lot)
Applicant Address 8201 N11 TH ST
City, State. Zip TACOMA WA98406-1101 Installer Name TJ Goos
Site Address 1765 E Burgundy RD,Shelton Designer Name Jim Tunny
INSTALLATION CHECKLIST
E Full System Installation ❑Tanlgsi Only ❑Drainfield Only ❑Repair ❑Other
System Type Pressure Distnbuuon Pretreatment Type
>5 ft. from foundation? ------- ----- -- ----- ------- - ❑WA Eyes ❑ No
>50ft. from wells? --- -- - -- - -- -- - -- - - - - - - - - - --- - ❑ ® ❑
Z >50ft. from surface water? - - - - - - - - - - - - - -- - - - - - - - - - ❑ ❑
HCleanout between building and tank? -- --- - -- - - - --- ---- - ❑ ❑
O Tankbafftespresent? - - - - - - - - - - - - - - -- - - - - ❑ ■ ❑
F 24-access risers over each compartment?- - --- -- - -- -- -- - - ❑ ❑
wEffluent finer installed?- - - -- - - - - -- - - - --- - - -- - - - -- - ❑ . ❑
y
Septic tank capacity (working) t500 dal Manufacturer in iltrator
0 D-box water level and speed levelers used? - - -- - - - -- ------ 0 NIA El YES NO
pJ
0 Manifold/D-box accessible from surface?-- - - --- - - -------- ❑ ❑
mZ Check valves installed? -- - - - - - -- -- - ----- - - - - -- -- - ❑ ❑
OQ:E Transport Line Size 2" Schedule/Class Scn 40
Bedrooms installed (cneek one) ❑ 2 ❑3 8 4 ❑5 ❑6 ❑CommerelaUOtner
>10ft. from foundation?-- - - - - - -- - - - - ❑ WA Eyes NO
0 >100 ft. from wells?- - - - --------- - - - - --- - -- - --- - - ❑ ❑
W >100 ft. from surface water? --- - -- -------- - - - - ----- - El ❑
u. >10ft. from potable water lines?- - -- - -- - - ----- El ■ ❑
QZ > 5ft. from property lines and easements?--- - ------ ---- -- ❑ ❑
K > 30 ft.from downgradient curtain/foundation drains? ---- -- -- - - ❑ e ❑
0 Drainfield level and observation parts present - - - -- - ❑ ® ❑
W Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?-- - - - - - -- - --- - - -- - - ❑ ® ❑
Pump tank setbacks consistent with septic tank?- - -- - - -- ----- [I N/A ® yes ❑ No
X Pump tank capacity(flood) 1500 at Manufacturer Infiltrator
Z - ❑ ® ❑
Q 24" access riser(s) and accessible from surface? - - - - -
~ Alarm or Control Panel Installed? -- --- -- - - - --- - - - - --- ❑ ❑
1 Control Panel equipped with Timer/tTM/Counter- - - - ----- - -
❑ ❑
7
a Pump installed in ❑ Bucket or ® On Block Of ❑ Other
G Pump Make/Model Liberty L290 ❑ Floats or ® Transducer
2
d Tank draw down 1 +" in/min Pump capacity 40.5 Opro Squirt Height 5' ft
Pump on time tmin 30 sea Pump off time 41vs Daily flow set et 360 Opd
W~umrm,s
Mason County OSS Installation Report pg. 2 Parcel If ZZ
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? YES NO
If yes, please describe'. !)fw'
Were all components pumped out andpr<perly abandoned per AC446272A0300? - - - ®..YES t10
RECORD DRAWING
niM1 n.p.�i nco,e sW T W rccu,M.NM Me,epIM mono b m,ow N nY rye,at°YbM°M.K ,,e iM r14[.eWNppmMt 1M R✓4E
wms cburvxlm pMs.c4arcaM1a.aM dM mal°MYYe arof]P+ �. Ar�mVMle Ret4U P'arYP^»cTdl°YpimilEysAnFNln9abtitn ilWwlliM,Nled Mn•rs.
"Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I certify thal I installed the system in accordance with /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 clearedlapprovod by both the designer shown here have been clearedtepproved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meal all
and Masnn CmeVy Cols ,State and Mason County Codas
I hither certify that e/I information contained on this 1 further cemly that all information contained on this
form and attached R/cord Drawing is accurate. form and attached Record Drawing is accurate.
Signature cllAst.)k', Date
Printed Name o/Sgnee
MASON COUNTY PUBLIC HEALTH F ,
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAYBE SCANNEDANDAVALABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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