HomeMy WebLinkAboutSWG2023-00282 - SWG As-Built - 6/5/2027 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APNffWANT1 PERMIT.
Permit Number SWG 2023-00282 Parcel# 320012160010
Applicant Name Pioneer School Dist. #402 Subdivision (Name/Div/Block/Lot)
Applicant Address 611 EAgate
City, State, Zip Shelton WA 98584 Installer Name Hanson Excavation LLC
Site Address 611 E Agate Rd Shelton We 98584 Designer Name Mike Williams- Evergreen Septic
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® Full System Installation ❑Tank(s)Only ❑Dminfiekl Only ❑ Repair ❑ Other
System Type Pressure Pretreatment Type_
>5 It from foundation? -------------------------- - ❑ NIA AYES NO
>50ft. from wells? - -- - ---- -- -- ---------- -- ---- - ❑ ® ❑
2 >50 ft from surface water? -- - - - - - --------------- - - ❑ It ❑
FCleanout between building and tank? ------- ----------- ❑ ❑
tl Tank baffles present? - - - - - - - - - - -- ---- ---------- - ❑ ❑
IL 24" access risers over each comparbir l?- --- ---------- - - ❑ ❑
W Effluent filter installed?- - - - -- - - - - - -- - - - - - - - - - - -- - - ❑ ® ❑
h
Septic tank capacity (working) 1500 qal Manufacturer Haggerman Precast
O,�II D-box water level and speed levelers used? - ------ ------- - ® NIA ❑ Yes NO
�O ManifoldlD-box accessible from surface?- - - - - -- - - -- -- --- - ❑ ® ❑
Oa
Q1Z Check valves installetl? - - - - - - - - - - - - - - - - - - - - - - - - - - Q ❑ ❑
Transport Line Size 2" Schedule/Class Sch 40
Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ®Commercial/Other
>1Oft. from foundation?- - ----- - -- - - - - - - - -- - -- -- -- ❑ WA ® yes ❑ NO
>100 h from wells?- - -- ----------- - - - - ---------- ❑ 0 ❑
>100 ft. from surfacewateR --- ------- --- ----------- ❑ M ❑
>10 R from potable water lines?-------- -------------- ❑ ® ❑
> 5ft. from property lines and easements?----- -- ------- -- ❑ ® ❑
> 30ft.from downgradient curtain/foundation drains?------ -- - - ❑ ® ❑
O Drainfield level and observation ports present - - - ------ --- -- ❑ ❑
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over dminfield?- - - - - - - - - - - - - - - --- - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - ❑ NIA ® YES ❑ No
Y Pump tank capacity (flood) 1275 gal Manufacturer Haggerman PreCast
R24'access riser(s)and accessible from surface?- - - - -- - - - - - - - El ® El
N Alarm or Control Panel Installed? - -TOL dAOTk�k - - - - -- - - ❑ ❑
IL
7 rp�
Control Panel equipped with Timer I ETM/Counte -LNJTM-LC� El El®
a Pump installed in ❑ Bucket or ® On Block or ❑ Other
Ill. Pump Make/Model Liberty 290 Q Floats or ❑ Transducer
Tank draw down 2 in/min Pump capacity 48 gpm Squirt Height 6 ft
a p
Pump on time3 11.5 min Pump off time O rS Daily flow set at -so gpd
uom,ea r.coe
Mason County OSS Installation Report pg. 2 Parcel# 320012160010
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - - YES NO
If yea, please describe: Old Septic Tank
Were all components pumped out and property abandoned per WAC246-272A-0300? - - - - - - - - ® YES ❑ NO
RECORD DRAWING
This Is a perm en —old and mule oe a un and descriptive di m re-locate In Pe had,or m. m mbnee a lw ctira and
mwrt develop w ldent Types,RaN
Pawiogs wdtem nremand a maodo n dramanon d leroul.sepuupmnv mnk bUeor.Nonn anw.lose,Nato°.-cling and 11.1.des dal,. bareir of wens wmx:mes,
tens ndvlvanon parts dHnoNa.and Inner mamManne aces°°poser. mdwnpry,ReGtld onwings may Deal,additional delays In Ina]insulation a ,loon MM headed pertnN.
K 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 clearad/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
1 further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
�fQ�tA.Gli f/1a44-&X- 5/9/2024 �R\CHAItO
S,gnahellof Installer Date
Jared Hanson ti
Printed Name of Signal
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
S�W� 6 CO2
Signature of EnNronmental HIcalth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE �°"i0O`a9'OB
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