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HomeMy WebLinkAboutSWG2024-00141 - SWG As-Built - 8/13/2024 Dacusgn EnwlW ID:83A40D03-F249J F-9129.A930FD128AS6 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2024-00141 Parcel # 22018-53-00112 Applicant Name Jess Ennis Subdivision (Name/Div/Block/Lot) Applicant Address g0 E VAUGHN PLACE TIMBERLAKE#5 LOTS_ 112-113 City, State, Zip Shelton Wa 98584 Installer Name Scott Johnson Site Address Same as Mailina Designer Name Micah Halverson INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only x❑ Drainfield Only ® Repair ❑Other System Type Gravity-Trench Pretreatment Type Septic Tank >5 ft. from foundation? --- ❑ NIA ❑YES ❑ NO >50 ft. from wells? - - - - - -- -- ❑ ❑ ❑ Z >50ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - - El ❑ ❑ HCleanout between building and tank? - - - - - ❑ ❑ ❑ O Tank baffles present? - - -- --- - - - - - - - ❑ ❑ ❑ a24"access risers over each compartment? - - - - - - - - - ❑ ❑ ❑ UJI N Effluent filter installed?- - - - - - - - - -- - - - - -- - - - - -- - -- - ❑ ® � ❑ Septic tank size gal Manufacturer 0 D-box water level and speed levelers used? - ❑ NIA x❑ YES ❑ NO QO Manifold/D-box accessible from surface?- - ❑ x❑ ❑ GaCheck valves installed? - - - - - - - - -- - - - -- - - - - ❑ ❑ x❑ g Transport Line Size 4" Schedule/Class ASTM 3034 Bedrooms installed (check one) © 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation?-- - - - - --- - - -- - - - - -- - - - -- - - ❑ NIA ® YES ❑ NO G >100 ft. from wells? - ❑ © ❑ W >100 ft. from surface water? - -- - - -- - ❑ El El M >10 ft. from potable water lines? - -- -- -- - ❑ ® ❑ QZ > 5 ft. from property lines and easements?- - ❑ ® ❑ K > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - - - - - - - - -- - - - ❑ ® ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- ❑ ® rp Pump tank setbacks consistant with septic tank? x❑ NIA ❑ICLI ZPump tank size aal Manufacturer 24"access riser(s)and accessible from surface? ❑ ❑a Alarm or Control Panel Installed? - - - - -- - - - - - - - -- - - - - - - ❑ ❑Control Panel equipped with Timer/ETM/Counter - , a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other d Pump Make/Model ❑ Floats or ❑ Transducer f 1 Tank draw down in/min Pump capacity apm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Upmreoa iaoia Docusgn Envelope ID:83A40D03-F249-446F-9129-A830FD126A8e Mason County OSS Installation Report pg. 2 Parcel n 22018-53-00112 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -- - - --- - - - - - -- - ® YES No If yes, please describe:Abandoned Failed Drainfiald used Ex'sf'ng Sant c tank Were all components pumped out and properly abandoned per WAC246-272A-0300? - - -- - - - - ® YES NO RECORD DRAWING TM1b Is a gmmmnr recoN and must bs accurate and denctlpeve enough to te-locate In Me need of maintenance a"i and house dwbpmaM Typkal Re oM Dreengs rosin DMiM ld&mMftW MWMM&Wyc ,SePWNmPtnnk tr m,Non i mi reserve dh itereld,doo n9 and pmyaM bi bnlim Novelle xaterllnes, µells,obsomelM po-LL,usmonts,and under heidwords,moves pards, Inmmihae Raced Drwnngs my aaate idhonal delays in[ al midaltbon eppmvel and nented pampa. x❑ 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 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 I further certify that all information contained on this I further certify that all information contained on this 2- f1 tched Record Drawing is accurate. formand attached Record Drawing is accurate. 8/9/2024 `- Signatureoflnstaller Date Scott Johnson \1�R Printed Name of Signee ,fir MASON COUNTY PUBLIC HEALTH $ The undersigned approves this Installation Report and '?- Record Drawing on behalf of Mason County Public MGENSEDD SIGNER Health: C� LICENSED DESIGNER fn1 C_^^ V( /� FJ(PIRES:Oa'1&1� Signature ofEnvironmentala Health`Specialist l Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE opd.lad8Q1101& 0 E m � m m (a O 'm o su xo � a, w . ism z — aa�z ° sm� Qss� � o g'a a > oo q`<332 3 -� . too �> a 1 1 1 I N 1 m 1y^] N 1 � A o + o C xs^ a A T o Z Z z C m -n z O �1 S' Z G) 3 m D A g 2 a` z m � T Z N m � o om T A Q1D0.^. Q 3' zv3xK -inS 3 yam -.ymmm N o m � uoo o � 0 1 ^ 7 mm y W -1O p A W O IT � Cmo . S 00 o 00 D 1 g T^� p9Y cZE m m Abbreviated Description: TIMBERLAKE #5 LOTS: 11 2-1 13 M.Halverson Design LLC (Tuner/Ann i,nY sna ioe,. SHEE MN R Jess nnis Parcel#22018-53-00112 PO Box 1519 Shelton Wa 98584 Mailing:g0 E VAUGHE N PL g0 E VAUGHN PLACE Asbullt Halversondesi nllc outlook.com Shelton wa98ssa