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HomeMy WebLinkAboutSWG2022-00620 - SWG As-Built - 6/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANTI PERMIT INFORMATION Permit Number SWG 2022-00620 "'ftu # 32126-23-94001 Applicant Name Ben Jenni sision (Name/DivBlock/Lot) Mgyo Applicant Address PO Box 1174 1 City, State, Zip Beflair WA 985 Install r Name Daryl Hemle Site Address 301 E. Hollo i t Rd, Shelton W r Name Rod Lett NSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type Standard Gravity Pretreatment Type >5ft.from foundation? ----------------- ❑NIA ®YES NO >50ft.from wells? -------------------- ❑ 0 ❑ Z150ft.from surface water? ------- ----------------- ❑ 0 ❑ FQ- Cleanout between building and tank? ------------------- ❑ 0 ❑ Ly Tank baffles present? ---------- ---- ---- ❑ ❑ 24"access risers over each compartment?---------------- ❑ 0 ❑ WL Effluent filter installed?------------------- ❑ ❑ ❑� N Septic tank size (25Q gal Manufacturer Hagemtan 0 D-box water level and speed levelers used? ----------- -- -- ❑ NIA ■YES ❑ No 5zJ 0O Manifold/D-box accessible from surface?----------------- ❑ ❑ g?Z Check valves installed? -- ------------- - ❑ ❑ ❑ 02 Transport Line Size 4" Schedule/Claw 40 Bedrooms installed(check one) ❑2 ❑3 094 ❑5 ❑6 ❑Commercial/Other 110 ft.from foundation?-- --------- --- ---- [I WA ®YES ❑ NO 0 >100 ft.from wells?------------------- -- ❑ ® ❑ W >100 ft.from surface water?------------- - ❑ ® El LL >1 Oft.from potable water lines?-- --- ❑ ® ❑ Z >5ft.from property lines and easements?------ ---------- ❑ ® ❑ K >30 ft,from dow igradient curtain/foundation drains?---------- ❑ 0 ❑ 0 Drainfield level and observation ports present --------- ----- ❑ ❑ ❑ Graveless chambers or M Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ W ❑ Pump tank setbacks consistant with septic tank?------------- ® NIA [-I YES ❑ NO Y Pump tank size gal Manufacturer z Q 24"access risers)anti accessible from surface?------------- � ❑ El~a Alami or Control Panel Installed? -------------------- - © ❑ ❑ Control Panel equipped with Timer/ETM/Counter-------- --- 0 ❑ ❑ 7 a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other o' Pump Make/Model ❑Floats or ❑ Transducer Tank draw down in?min Pump capacity a gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Mason County OSS Installation Report pg. 2 Parcel It ABANDONMENT RECORD Were existing septic components abandoned as pan of this project? -- -- - --- - - - - - - - ❑ YES JK NO If yes, please describe'. Were all components pumped out and property abandoned per WAC24&272A-0300? - - - -- - - - ❑ YES ❑ NO RECORD DRAWING rna le•..m•.nem MON me meet ee—.1.-d d...A lne enouee m-I--m Ib- W W m.mbn.rc..6nM .nd n Pum dwalol-1 TIP.Rx orewipe mnt.: oM:MNnmW.bM aMnlabn at,1.Seplk.Wmp.Mr ..WM—..rm.Mmnrwa..A.....nd praPa.W WWM .I—.W M11.vN.mne.. walla,PP.um Pale,tl°.^^ee.end oWw meNlenenm mas Part. IrFwnPM.R..91 nuy mWe P0.11W d&11In mY i--PP1P m eppmrel—"soP pemPla. 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 Meson County Public Health and that any deviations here have been cleerecVapproved by both the designer shown here have been cleared/approved by both and Meson 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 PtQ nd site had cord Drawing is accurate. form and attached Record Drawing is accurate. e Sig(nn�aatu Installer Date IJarl I Kx4nt5=4 Pnnted Na(de of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and *EXPIRES121151 Record Drawing on behalf of Mason County Public Health: ��yr�y1�YY11N ^' m Signature of Environmental Reald,Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WES SITE eWaW name a \ Q \ ; \ � \ .......... � * R O � ...�\ § LIP $ § w�"� m & %[ z � k\ d$ ` 2& . � 5 ®» —' - � � ui _mee ^ » \ — _ ) y ACC_�eI)RI . : . d2 /\ EASEMENT aU, \ uj . � � ° . & ( § \ ° < »a> k , = z e ; \ 0 A � » R , bLu 0 ! / I ] \ S . § } ! -jke aq : ! , e \ a / m / }\ § 2\ 0 : TO «� / � L \/ \ } § w / oz : ! « ! - §/ § U itJw ! _ w / 4 � ` \\ \ \ � \ k \ R ($ zww ` Z ! B § §\ @ § [Lzf ; m g Iq ( ( 5F- _ & � < o �® 0 �R oj ! ` ± )w § } § « » B ` \ \ § / � kuEr a h \ < < W ) g [ : [ § § Pff & � @ ƒ 0Lij 5ZQ- 0 w @2 » ( ° ° ° § ? § \ � § wpo \ w § \ ec i ! ! § \ ] } « u \ \ 0E-b msm' 0 < < zo0 <