HomeMy WebLinkAboutSWG2023-00065 - SWG As-Built - 6/27/2024 LV
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SyvG 2023-00065 32126-23-94002
Applicant Name Brandon Wolf ��`. " VS ion (Name/Div/Block/Lot)
Applicant Address PO Box 1032 Z
City, State, Zip Shelton,WA 9858 Insta r ame Jon Johnson
Site Address 501 E.Hollow int tl Shello De Name Rotl Left
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑Drainfieltl Only ❑Repair []Other_
System Type Standard Gravity Pretreatment Type
>5 ft.from foundation? --------------------------- ❑WA AYES ❑ No
>50 ft.from wells? ----------------------------- ❑ 0 ❑
Z >50 ft.from surface water! ------------------------ El
FCleanout between building and tank? ------------------- ❑
L) Tank baffles present? --------------------------- ❑
F- El
access risers over each compartment?---------------- ❑
W Effluent filler installed?--------------------------- ❑ ❑
N
Septic tank size 1000 X2 oat Manufacturer
o D-box water level and speed levelers used? --------------- ❑ wA EYES El No
DO Manifold/D-box accessible from surface?------------------ ❑ e ❑
InZ Check valves installed? ---------------------- ---- ❑ ❑ ❑
OQ
2. Transport Line Size 4" Schedule/Class 3034
Bedrooms installed(check one) ❑ 2 ❑3 ❑4 ❑5 E 6 ❑Commercial/Other
>10ft.from foundation?-------------------------- ❑ NIA WYES ❑ No
>100 ft.from wells?---- ------------------------- ❑ W ❑
-� >100 ft.from surfacewater?------------------------ ❑ 0 ❑
w
ti >10 ft.from potable water lines?---------------------- ❑
„Q >5 ft.from property lines and easements?---------------- ❑ [] ❑
K >30 ft.from downgredient curtain/foundation drain?---------- ❑ ® ❑
Drainfieltl level and observation ports present -------------- ❑ 0 ❑
❑ Graveless chambers or E Clean gravel used? (check one)
Proper cover installed over drainfleld?------------------- ❑ ❑� ❑
Pump tank setbacks consistent with septic tank?------------- 0 wA ❑ YES ❑ No
Y Pump tank size at Manufacturer
Q24"access riser(s)and accessible from surface?------------- ❑ ❑ , ❑
F Alamt or Control Panel Installed? --------------------- ❑ ❑ ❑
a
� Control Panel equipped with Timer/ETM I Counter----------- ❑ ❑ ❑
7
o- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a Pump Make/Model ❑ Floats or ❑Transducer
a
Tank draw down in/min Pump capacity opro Squirt Height ft
Pump on time Pump off lime Dairy flow set at gpd
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Mason County OSS Installation Report pg. 2 parcel o 32126-23-94002
ABANDONMENT RECORD
Were existing septic comon pents abandoned as part of this project? --------------- ❑ YES No
If yes, please describe:Were all components pumped out and property abandoned per WAC246-272A-0300? -------- ❑ YES ❑ No
RECORD DRAWING
Txla 1a a pTraMnr rvrJ aM mYal M acNM MO MOIptlM anDugY b nbub In tlu rwE al mNnrxra,e aCWMYa and rNYn EaMepnaN. ryMW R. rtl
Drewln�wntyn: DraiMMltl 8 menlal0 arimbAm 6 WywS SapG/PaW bnk bratlen,NwN armw,reeerre 6andietl,emYrg aM ggwk W Wrge,tuYcn dweNa,walMlrree,
walk,WeervaNn paR,Wanw4,aW oTer meYitenmu a®v pin6. Ymngele RerorC OrtMrya may aeab tlMwwl GNM�^tlrW Irmlalletlm eppwN aM re'a1M pwmN.
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I oertity,that I installed the system in accordance with I car*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 myselt and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all intormation contained on this I further certify that all information contained on this
to nd at ad Record Drawing is accurate form and attached Record Drawing is accurate.
MM 6-20-2024
S mA& ofl taller Date
n
Jack Johnson
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and 101i
icfns iexER
Record Drawing on behalf of Mason County Public
fillPIBES Y3 N512-r{
Health:
Signature of Environmental fJealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SUE Wpjp°�"40i8
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