HomeMy WebLinkAboutSWG2021-00492 - SWG As-Built - 8/28/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
=5333E.
PPLICANT/PERMIT INFORMATION
er SWG 2021-00492 Parcel# 22016-12-90104
e Lod Schmidt Subdivision (Name/Div/Block/Lot)
ress 5333 E.Pickering Rd.p Shelton,We 98584 Installer Name Mike Schmidt(owner)
Same Designer Name Bob Paysse
INSTALLATION CHECKLIST
Full System Installation ❑Tecge)Orly ❑DraiMreld Only ❑Repair ❑Other
System Type Pressure Pretreatment Type N/A
>5 ft.from foundation? ---------------------------- ❑ wp Wyss ❑ aO
>50ft.from wells? ---------------------------- - ❑ ® ❑
14 >50ft.from surface water? -______________________- ❑ ❑
FCleanout between building and tank? ------------------ - ❑ ® ❑
V Tank baffles present? ------ -- -------------------
24' ❑ ® ❑
aaccess risers over each compartment?-______________- ❑ ❑
rW Effluent filter installed?----- ----- ----------------- ❑ . ❑
Septic tank capacity(working) 1500 gal Manufacturer sound Placement
�O D-box water level and speed levelers used? -_____________- a� ❑� ❑�
flu Manifold/D-box accessible from surface?--__---_
G4 Check valves installed? -----
--------------------.- ❑ ❑
2 Transport Line Size 2' SolmdulallrAn 40
Bedrooms installed(check one) ❑ 2 ❑3 04 ❑5 ❑6 ❑CntnmerciaVother
>10ft.from foundation?--------------------------- WA ❑yes 1300
C >100 ft.from wells?-_ __________________________- ❑ . ❑
W >100ft.from surfacewateR-______________________. ❑ ■ ❑
>tOfl.from potable water lines?---------------------- ❑ ❑
>5ft.from property lines and easements?--------------- . ❑ ■ ❑
>30ft.from downgradient curtaiNfoundation drains?----_---_- 0 ❑
Drainfletd level and observation ports present ----- ❑ ❑
❑ Graveless chambers or E Clean gravel used? (check one)
Proper cover installed over drainfield?------------------ - ❑ ■ ❑
Pump tank setbacks consistent with septic tank?------------- ❑ WA El Yes ❑ No
zY Pump tank capacity(flood) 1500 oat Manufacturer Sound Placement
F 24"access nser(s)and accessible from surface?---------------------
❑ ® ❑
y Alarm or Control Panel Installed? --------------------- ❑ ® !❑
Control Panel equipped with Timer I ETM/Counter----------- ❑ e ❑
IL Pump installed in ❑ Bucket or ® On Block or ❑ Offmr
C Pump Make/Model . Liberty FL 51 M
jz�ttFbets or ❑ Transducer
a Tank draw down 1.5' in/minPu EE eight 33" t(
Pump on time 1.5 minutes Pu 1h,now set at 400 god
SIASON COUNTY ENVIRON rVaerrnrr�
HEALTH
JB W MENTAL
Mason County OSS Installation Report pg. 2 Parcel# 22016-12-90104
ABANDONMENTRECORD
Were -Xisbng septic components abandoned as part of this Project? -------------- _ ❑ VEs ® NO
If Yes, Please describe:
Were all components PamPed Oat and PmPeflY abandoned Par WAC246-272A 0300? ------- -
❑ YES ❑ No
RECORD DRAWING
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APPROVE
AUG 2 A 2024
MASON COUNTY ENVIRONMENTAL
JBW
■ 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 accror-
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 c/earedrapproved 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 Meson County Codes. State and Mason County Codes
1 further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
h _
Signsnr��Iler Date
Mike Schmidt
Printed Name of Sgnes
MASON COUNTY PUBLIC HEALTH f
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public ""
�: rxPiaae
Sg Ennm.da t�alth Daa
(stamp,signature and date)
THIS FORM MAYBE SCANNEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SRE epeM.earzrnsre
MINIMUM 30Ff TO ANY DOWNSLOPE
FOUNDATION/CURTAIN DRAINS
/ ----- — -----
PROPOSED /'' — j
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DRAINFIFED--- p \ I
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% 4 APPROX. PROPOSED I I I
WELLLOCATI,6N I
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4 BUILDING 51TE
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( APPROX. PROPOSE[)
TANKS i
PP
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SEPTIC COMPONENTS
LINES TO WATER LINES
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