HomeMy WebLinkAboutSWG2024-00176 - SWG As-Built - 8/14/2024 Mason County OSS Installation Report pg. 7 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG Zoe- oo n 6 Parcel# y20/ 3- yZ -00190
Applicant Name 202z -T,4yc-96,,." Subdivision (Name/Div/Block/Lot)
Applicant Address q I? PAcf"F� s-uc. 3�1
City, State, Zip fr1 1n�11 Wk ,012 Installer Name �lt
Site Address S� oF) Designer Name Se I e
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)O ly ❑ Drainfeld Only Repair ❑Other
�i
System Type I Pretreatment Type
>5 ft.from foundation? - ----- ----- -- - ---- M NIA YES ❑ NO
>50 ft.from wells? --- ------- -- --- e�y ,L,,v,-_�,,// ❑
Y >50 ft.from surface water? --- - -- - - - -- -
--- - Lr7 ❑
FZ L7 ❑
Cleanout between building and tank? -- --- - _RT�2 2D24
V Tank baffles present? - --- --- -- - - - - -- - -- - - ---- [��/ ❑
C 24"access risers over each compartment?- --- --- - Lr� ❑ /
W Effluent filter installed?----- -- ----- ---- y -- --- --- ❑ ❑ •L•`-1•/
W
Septic tank capacity(working) 1220 O gal Manufacturer /
O D-box water level and speed levelers used? -- ----- -- ----- - B A ❑YES ❑ No
p0Manifold/D-box accessible from surface?- ---------- ---- / ❑ ❑
mZ Check valves installed? - - ------- - - - ------ -- - ----- Lug ❑ ❑
C2 Transport Line Size Schedule/Class
Bedrooms installed(check one) ❑ 2 E113 ❑4 ❑5 ❑6 ❑Commercial/Other
>10ft.from foundation?-- - - - - - - ----- - - - - - - ----- -- ❑ NIA 031YES ❑ NO
>100 ft.from wells?--- ------- --- -- --- -- -- ------- ❑ ,[[I.�/ ❑
OJ >100 ft.from surface water? - -- -- -- --- ------- ----- - -LI
❑ ,L.,/ ❑
lL >10ft.from potable water lines?- -- -- --- ----- ----- --- - ❑ Ly ❑
QZ > 5ft.from property lines and easements?----- -- - - - - ----- ❑ Fa,
/ ❑
K > 30 ft.from downgradient curtain/foundation drains?------ - - - - ❑ [��,'/ ❑
Dminfield level and observation ports present ----- - ❑ Ly ❑
[WGraveless chambers or ❑ Clean gravel used? (check one) - /
Proper cover installed over drainfield?---- ----- ------- --- ❑ (tY ❑
Pump tank setbacks consistent with septic tank?-- ---------- - ❑ NIA YES ❑ No
Y Pump tank capacity(flood)_�000 _gal Manufacturer irinM,.-1,/
Q24"access riser(s)and accessible from surface?-- ----------- ❑
FFal
a Alarm or Control Panel Installed? ------ ------- -- ----- - ❑ — / ❑
Control Panel equipped wi Timer/ETM/Counter-- --- -- - -- - ❑ I(�' ❑
7
IL Pump installed in ucket or [] On Block or ❑ Other
I
pp
Pump Make/Model CJ� �7� loafs or ❑ Transducer
5-
IL /
Tank draw down 3 in/min Pump capacity (LO ppm Squirt Height ft
Pump on time -30 S� Pump off time 2- Daily flow set at9pd
U� WIM"e
Mason County OSS Installation Report pg. 2 Parcel u
ABANDONMENT RECORD
Were existing septic cornp�g)nants abandoned as pan of this Profe1glP -�-+---- YES .p NO
If yea, please describe: IUT Frf,(&/ totd7 b1L5 ! r=x15d� $'s/!sc 71 -)
Were all components pumped out and property Abandoned per WAC246-272A-031RY1 ----- -- OYES NO
RECORD DRAWING
TIrI.I..perer.aea r.aara.eu rear Iw.aeurw am n..angw..aaaln to rrweam m ma aaw a mallMnarcw aerNMW.m NNr.e..ewpm.M. ty*W Rwwa
orpw`o.aan�.n, omwrew A melww merrwwa s Irywn,sapulp,mp knxwwmn,rwrm maw.raeerwnreMew,awnlra ape prWaeaU paarae.wreuan awew.wwnre.,
walk peeervallan Wrk seapW,mE alMrmWYpewnea mmaa po4N. In.Maba RemN DraA,may eaab etlO1bW 1N 0 b final YWelwwn pprnY and NWtl perm!..
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 ScCOr-
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 cleamoVeoproved by both
and Mason County Public Health and meet all State myself and Meson County Public Health and meet all
and Mason County Codes. State and Mason County Codes
1 r d certify that all Information contained on this I further certify that all Information contained on this
a eltaclled cons rawirg is accurate. form and attached Record Drawing is arxurate.
Signet of stager Date
Iry 1 �em\,C4
Printed Am of Sign"
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health: amarnan�
Sfgnefum of EnvkonrneM Health Spedallat Date (stamp,signature and date)
THIS FORM MAYBE SCANNEDANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
WEST H STREET,SHELTON, WA.
A 7ETER 3)5D'PRESSURE SAND LINE TRENCHES
BOX ON&CENTERS
PPROX.WATE
LINE o
EXISTING
HOME
NEW BE ANK
NEW PU ANK
-BOX
WITH RISER
LEEVE
w
8 4w9
MISTING GA GE
NO PLUMBING
215 eN.)
215 N
a \ a
LINE X.WATER RECORD
LINE
OF
CONSTRUCTION
y s r 0/
2 N
N ( ROC)
m r
rn
s as
s
20'
DW o 5 40' 40 - /A�/I/
V
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N j
X O
w 2 DIBCW M4R
llibmep roes no-reyresenta ancr
mrecesnpuryoM1 hmnm,if my en's
emoxemenn.vans.
0' 30' 60'
OWNER: SCALE:
DAVE'S SEPTIC SERVICES INC. 1"= 30'
WALLACE FRENCH DATE:
541 WEST H ST Im
P.O. BOX 301 3/28/2024
SHELTON, WA98584 SEABECK, WA 98380 REVISION
TAX ID: 42013-42-00190 (360) 710-2449 41712024
REVISION:
711012024