HomeMy WebLinkAboutSWG2024-00118 - SWG As-Built - 8/6/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00118 Parcel# 41903-00-90090
Applicant Name Patsy Johnson Subdivision (NameWn
,qUApplicant Address 151 W Wivell Rd TR 9 OF S', SW T G(�City. State, Zip Shelton,WA 98584 Installer Name tin FCCSite Address Same Designer Name es. nsINSTALLATION CHECKLIST
FullSystem Installation ❑Tank(s)Only ❑ Drainfield Only Repo
System Type Shallow Pressure Pretreatment Type
>5 ft from foundation? -- ---------------- ❑ NIA ®YES ❑ NO
>50 If from wells? -- -- --- - - - - - rL-
LU � -� ❑ ® ❑Z50 ft. from surface water? -- - - - - -Cleanout between building antl tank? -- -7{?;21}- ❑ ® ❑Tank bafFles present? --- - - - - -- - - - - ❑ � ❑a~ 24"access risers over each compartme Effluent filter installed? - -- -- ❑ ® ❑
Septic tank capacity(working) 1250 Oal Manufacturer Snyder 2-Compartment
0 D-box water level and speed levelers used? -- - - - - - - -- - - - - ❑ NIA ❑ YES QNO
DJ
O Manifold/D-box accessible from surface?-- - -- - - - -- - - - - - - - ❑ ® ❑
mZ Check valves installed? ---- -- --a:-'- -"'-"-Qa"�'- - - - ❑ a ❑
OQ
r2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 W 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
110ft. from foundation?- - - - - - -- - - - - - - - - - --- - -- - - ❑ NIA ® YES ❑ NO
1100ft. fimmwells? - - ----- - - - - - - -- - - - - -- --- - - - - ❑ ® ❑
w >100 ft.from surface water? ❑ ® ❑
M >1Oft. from potable water sines?- - - - - - - -- -- - --- - - - - - - - ❑ ❑
Z 5 n from property lines and easements ElON ❑
K > 30 ft.from downgradlent curtain/foundation drains ❑ ® ❑
Dram eld level and observation ports present - - - - - - - - -- - - - ❑ 111 ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield? ❑ Q ❑
Pump tank setbacks consistent with septic tank?-- - - - - - - - - - -- ❑ NIA ® YES ❑ NO
`1 Pump tank capacity (Flood) 1000 gal Manufacturer Existing Concrete
Q24" access risers)and accessible from surface?---- - - - - - - - -- ❑ W ❑
F- Alarm or Control Panel Installed? ❑ 0 ❑
a
f Control Panel equipped with Timer/ ETM/Counter- - - - - - - -- -- ❑ ff ❑
0. Pump installed in ❑ Bucket or ® On Block or ❑ Other
1 Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer
:3 Tank draw down 2.25 in/min Pump capacity 43 grim Squirt Height 7 ft
a
Pump on time 2 Minutes Pump off time 6 Hours Daily flow set at 360 gpd
Mason County OSS Installation Report pg. 2
Parcel r# 1\ IOV 0 V—gbgy
ABANDONMENTRECORD
p - -- _ - _ - __ - -__ - . YES NO
Were existing septic components abantloned as part Of [his p'ojec[ p ^ N
I`yes, please describe: ® yE5 NO
Were all components pumped out arc property abandoned per WAC24E-272A-0300? - ----- --
RECORD DRAWING
pure enau ce activ2as antl M1rture aevelopmene 1Wi.I R..
m a puma mr r.apm ana m�:v a a-m a n =sJns ana p p c e uensa.lpcaca ot.aua.waatinez
p �9s mnulrt prarmeaema9rolao. ti B'ay unae pon pt P,,,
n Inrcm I � Ru.ora D s meY a ad Aoml EeLays fi I Ilanon approval sna relarza pvmrt
cells,eEssrcaeon papa,tleanmu,antl other ma:n[enan¢ c _ Pe
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that 1 installed the system in accordance with 1 certify that the system has been installed in accor-
the septic design stamped"APPROVED"by Mason dance wdh 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 shovm here have been cleamatfapproved 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
I further certify that all information contained on this 1 further certify that all information contained on this
form and attached Record Drawing is accurate. Term and attached Record Drawing is accurate.
'Signature of Installer DateQ "��ptlr\xI�
Printed Name of Signee ^'
MASON COUNTY PUBLIC HEALTH r f,
The undersigned approves this Installation Report and
PAULA JUY JOHNS04
Record Dawing on behalf of Mason County Public
Health: �'�sgBass U911151 �� +
Signature of Environment I Health Specialist Dare (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC OEVv ON THE MASON COUNTY VIES SITE uWrec arz''rzo�e
IN x50. prkmar� e s 3o as
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Valve Control Box
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