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Home My WebLink AboutSWG2023-00172 - SWG As-Built - 8/6/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2023-00172 Parcel# 320275005001 Applicant Name Chambers Thomas C Subdivision (Name/Div/Block/Lot) Applicant Address 5377 SE Arcadia Road City, State, Zip Shelton WA 98584 Installer Name Menke Excavating, LLC Site Address 1900 SE Arcadia Road Designer Name James Excavatinq Co INSTALLATION CHECKLIST ❑ Full System Installation Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pretreatment Type >5 ft.from foundation? - ---- -- ❑ NIA ®YES ❑ NO >50 ft.from wells? - -- - - - - - ----�c-a El ❑ 14 >50 ft.from surface water? - - - - -- ❑ ■ ❑ Q Cleanout between building and tank? El--- El ❑ H ' V Tank baffles present? - - -- -- - - - - - - -- -- -- - -- - -- --- ❑ 0 ❑ F- 24"access risers over each compartment? 6 JY:�____________ _ - ❑ ® ❑ Ul 113 Effluent filter installed?- ---- ❑ N El Septic tank capacity(working) gal Manufacturer O D-box water level and speed levelers used? - - - ---------- - - N/A ❑ YES NO O0 Manifold/0-box accessible from surface? -- - ❑ "?= Check valves installed? - -- -- - - - - -- -- - - - - - - - - -- --- ❑ ❑ O Transport Line Size Schedule/Class Bedrooms installed(check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?- -- - - - -- -- -- -- -- -- -- -- - - -- ON/A ❑ YES ❑ NO G >100 ft.from wells?- - - ----- - -- ------ - - - - - - - - -- -- 0 ❑ ❑ W >100 ft.from surface water?--- - - --------- - - - - - - - - - - ® ❑ ❑ ti >10ft.from potable waterlines?- -- - - - - -- -- ❑ ❑ QZ >5 ft.from property lines and easements?- -- -- -- - ❑ ❑ N >30 ft.from downgradient curtain/foundation drains? - -- -- -- -- - e ❑ ❑ Drainfeld level and observation ports present -- S ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- --- ------------- ❑ ❑ Pump tank setbacks consistent with septic tank? NIA ❑ YES ❑ NO Y Pump tank capacity(flood) gal Manufacturer $ 24"access nser(s)and accessible from surface?------------- ❑ ❑ d Alarm or Control Panel Installed? ------ - -- - ---------- - ® ❑ ❑ Control Panel equipped with Timer/ETM/Counter-- - - -- -- -- - ® ❑ ❑ d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other IL Pump Make/Model ❑ Floats or ❑ Transducer f M Tank draw down in/min Pump capacity gpm Squirt Height fit Pump on time Pump off time Daily flow set at opd up .si "xu Mason County OSS Installation Report pg. 2 Parcel if 320275005001 ABANDONMENTRECORD Were existing septic components abandoned as part of this project? - - - -- - - N YES El No If yes, please describe:Tank had been Dreviously pumped and filled with gravel during home demolition Were all components pumped out and property abandoned per WAC246-272A-0300? -- - - - --- ® YES 0 NO RECORD DRAWING Thu N a pamuaant.1d eM muN be-...and dee 01p enough ro n�In Me need a melnbre aN,irin a U.tlm rid. T,➢ Re Drew p¢ n: Dnmfieldam ronxi wwwron a layout SeOUWnn dnk Ig fian.North arm-.ffla dMeW.misting and prpnsed wmN ,Iwaum N wells.wamRles. wells,aMervedcn pane,aaeroum,and weer melnlenan®amm pdnK. Imm�npele ReroN tMe-ims may aeere edMkxnal tlelays in rirel immlmtiwn wWoral eM MalaJ pe'mib. ® 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 acoor- 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 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 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. .S-.2 �191gnature of Installer Date &� r nL Printed Name o ignee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: Ela t <<-M Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE up mw W1nme RECORD DRAWING condnued 00 D2�Vc�wa� M yowTO Za r Ld APPROVED AUG 0 6 2024 MASON COUNTY ENVIRONMENTAL HEALTH RET