HomeMy WebLinkAboutSWG2024-00187 - SWG As-Built - 7/2/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00187 Parcel# 32127-50-00187
Applicant Name Joseph Maulden Subdivision (Name/Div/Block/Lot)
Applicant Address 41 E Lambeth Way Lake Umedck Division: 1 Lot 187
City, State, Zip Shelton,WA 985a4 Installer Name Maples Excavating
Site Address Same Designer Name Arrow Septic Designs Inc
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ®Repair ❑Other
System Type Shallow Pressure Pretreatment Type
>Sft.from foundation? --- ----- -- --- - - -- - - -- ----- ❑NIA ® YES ❑ No
>50 ft,from wells? -- - - --------- - -- --- - - - - -- -- - - El El>50ft.from surface water? --- - ---- - - - - - - -- - - - - --- 1-1 ❑
hC
Z Cleanout between building and tank? ----- - - - --- - -- -- - - - ❑ ❑
O Tank baffles present? - - - ----- - - - -- - - --- - - -- — - - - ❑ 0 El
R24"access risers over each compartment?-- - - - -- - - - - -- - -- ❑ 0 ❑
W Effluent fitter installed?--------- -- - - - - - - - - - - - -- - - - ❑ 0 ❑
N
Septic tank capacity(working) 1 200 Oal Manufacturer Existing
0 D-box water level and speed levelers used? --------------- ❑ N/A ❑ YES NO
0O Manifold/D-box accessible from Surface?-- --�` �-- ❑ ® ❑
E?Z Check valves installed? - - - -Q'^-'��7'--y-- - ---- -- - -- El El
OQ
f Transport Line Size 2" Scheduie/Class 40
Bedrooms installed (check one) ❑2 ®3 ❑4 ❑ 5 ❑8 ❑Commercial/Other
>10ft.from foundation?- - - --- - ---- - - - - - - El WA ® YEs ❑ NO
13 >100 ft.from wells?- - - ------- -
❑ ❑
U >100 ft.from surface water? - --- - -- --
❑ 0 ❑
M >70ft.from potable water lines?- - - - -- - --- - - - - --- - --- - ❑ ❑� ❑
ZZ >5ft.from property lines and easements?--- --- - - -- - -- - - - ❑ ❑
K >30 ft.from downgredient curtain/foundation drains?--- - ---- - - ❑ ❑
Drainfield level and observation ports present - - ---- - ------- ❑ ❑
❑ Graveless chambers or M Clean gravel used? (check one)
Proper cover installed over drainfield?--- - - ---- - --- -- -- -- ❑ ® ❑
Pump tank setbacks consistent with septic tank?-- --- -- -- - --- ❑ NIA 0 YES ❑ No
Y Pump tank capacity (flood) 1,250 at Manufacturer Norwesco/Snyder
z
FQ 24-access dg si
c ccessible m fro surtace9- - -- --- -- -- -- 1-1
a Alarm or Control Panel lnstalletl? - - --- - - - - - - - - ❑ ® ❑
Control Panel equipped with Timer/ETM/Counter-- - ❑ ® ❑
a Pump installed in ❑ Bucket or ® On Block or ❑ Other
a Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer
a
Tank draw down 1.75' iNmin Pump capacity 60 gpm Squirt Height 6 ft
Pump on time 1.5 min Pump off time 6 Hours Daily flow set at 360 gpd
Jp�ttaJ Nl1208
Mason County OSS installation Report pg. 2
Parcels Zn 121—�-OOIFJ�
ABANDONMENTRECORD
® NO
o YEB
Were existing septic components abandoned as par of this�prcject n
if yes,please describe: * , No
Were all components pumped out and property abandoned per WAC246-272A-0300? ' YES
RECORD DRAWING
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® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
I certify,that 1 installed the system in accordance with l certily that the system has been installed in accor-
the septic design stamped"APPROVED"by Mason dance wth 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 cleare&approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet a//
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this l further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
G IG � y 627-Si/gnature of Installer Dat Date
`J✓(Ltdl� (i.f�� � o
Printed Name of Signee ia° we
MASON COUNTY PUBLIC HEALTH - 1
The undersiB^ad approves this/nsta0a.P RAPP,and ) --1-
RecordDrawingonbeha/fof Mason County Public [�•(�LdP±AUL�A JyOYJOHNSON';
Hel� Z Z
Sg1f1f nature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC ViEWON THE MASON COUNTYWES SITE PWaaa✓1=1*
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3 1200 Callon Septic Tank
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APPROVED
jUL 02 2024
MASON CCUNTY ENVIRONMENTAL HEALTH
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