HomeMy WebLinkAboutSWG2021-00615 - SWG As-Built - 7/18/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2021-00515 Parcel# rf ZIZ71L}c/t(-p/�
Applicant Name Karin Vartla Subdivision(Nama/Div/Rock/LOt)
Applicant Address 7002 Bailey ST 5/P 3 )*3 Li- Z
City,State,Zip Olympia,we.88513 Installer Name _Timberline Excavating LLC
Site Address `/Ad California Rd.Shelton wa Designer Name Jim Henry Design Services
INSTALLATION CHECKLIST
®Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other
System Type Sand lined pressure Bed Pretreatment Type N/A
>5 ft.from foundation? -____________________
----- ❑NIR ®YES ONO
>SO ft.from wells? -----------------------------
❑ ❑
Y >50ft.from surface water? ------------------------ ❑ ❑
f Cleanout between building and tank? ------------------ - ❑ ® ❑
O Tank baffles present? --------------------------- ❑ 0 ❑
F- 24"access risers over each como. partment?---------------- ❑ ❑
NEffluent filter installed?--________________________- ❑ ❑
Septic tank capacity(working) 1250 gal Manufacturer Hagerman
0 D-box water level and speed levelers used? ---------
------ 0NtA ❑YES ❑ NO
C0 Manifold/D-box accessible from surface?----------------- ❑ ❑
G— Check valves lnstallatl7 -- -____________________ ❑ ❑
Transport Line Size 2 Schedule/Clan 40
Bedrooms installed(check one) ❑2 ❑3 ®4 ❑5 ❑B ❑CgmmsrcfsWther
>10ft.from foundation?--------------------------- ❑NIA ®YES (] NO
>100 ft.from wells?--------"--------------------- ❑ ® ❑
W >100 ft.from surface water?-______________________- ❑ ® ❑
z >10 ft.from potable water lines?---------------------- ❑ ® ❑
>5ft.from property lines and easements?--------------- - ❑ ❑
>30ft.from downgradient curtain/foundation drains?----------13 ❑ ❑
Drainfield level and observation ports present ----- ❑ ® ❑
IN Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainflekl?-----_____________ - ❑ ® ❑
Pump tank setbacks consistent with septic tank?------------- ❑ WA ❑ YEs NO
= Pump tank capacity(flood) 1250 oal Manufacturer Hagerman
f24"access riser(s)and accessible from surface?------------ - ❑ ® ❑
a Alarm or Control Panel Installed?--------------------- ❑ ® ❑
Control Panel equipped with Timer/ETM/Counter--- -------- ❑ ® ❑
a Pump installed In IN Bucket or ❑ On Block or ❑ Other
fPump Make/Model Liberty 280 ®Floats or ❑Transducer
IL Tank draw down 1.5 In/min Pump capacity 80 rpm Squirt Haight 6 ft
Pump on time 1A8 Pump off time 4hours Daily flow set at_ 380 npd
Vyap,I12VY�1B
Mason County OSS Installation Report pg.2 Parcel#421271404010 lot 1
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -------------- - YES ® NO
If yes.please descnbe:
Were all components pumped cut and properly abandoned par WAC241F272A.03007 ------- - EYES NO
RECORD DRAWING
Vd.N.p•�m.d.m rw.ra.na mp,l u ..a a,...pa•.....s —In.........mas...,wa...mpm..r. Twi.a a...rd
"In meaaa aNnNsa,air,r.n.S.paas."NnsI—s.n Ns-..o... 411nrae.,amns.na n,,NwN,.a.nnn.I nn,w,mxn.,.
.,.e.,.m.,.eionppn.,a..n.pN,pm an.mam.n,rce,nr�.pNne. Inwnwl.a N«wa m,.+ns.m,r=••i.,a&upne aa.cem nn,i wmll.npn.pwp.,I,m am.a ce,.ie.
® 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 del 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
I further certify that all information contained on this I further certify that all nformation contained on this
form and a�ttaacchhhed Record Drawing is accurate. form and attached Record Drawing is accurate.
��" '^^.J-__ 7113/24
Signature of nstaller Date
Tate Choate
Printed Name o/Signs& 71111Lf
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and bey$ T>'o a' ^r,
Record Drawing on behalf of Mason County Public __ Sp20W834 .,
Health• ��M/����/�yy���yn�// /h/w IC N�UMS
— Lla •' " 1112) 1
S/gneture ofEnvironmemla Health Spec/arlsl Date (stamp,signature and date)
THIS FORM MAY BE SCANNEDANDAVAIL BLE FOR PUBLIC VIEW ON THE MASON CWNTY WEB SITE Wa. lemon&
/
/ o v
� m �
O
O
m
,�11
38,
t`
/ 5 20
/ AZ>
z
A i 9
/ T
/• / T
/ / I
/ T
rm 03: � po 0®®00
O A
Q :E < unAm cmYYm
0 `a2m r 00
ZOO MO = HO 'm M .
^ m Am Z vN /
N C
F>A me OOD m m -9+ "
> y0 0 >DxMo O
0OZ DZF20 0 DZ
CMz i0 = m m � xtf
ZZ All PON Z
Mm O\ m
> a N3 m A r
Z n 0 Z <
Om y m
n � Tm
> Z F
Cj
/ � 7
Ta /
w m m M a c 0 , / �4+Poa�
x
cFr�i y r o 5� D
m A w m 75551'
w � y n m
0
u! sso.is•
A z0
> — F z
n s p< > C
z
>v $
2 _ a NO
m z r
n a o U- r
> c C n
0
=n A A
m 9 N
o Z
0