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Home My WebLink AboutSWG2023-00486 - SWG As-Built - 8/26/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number swG 2023-00486 Parcel # 32008-42-90160 Applicant Name ANTONIO ESTEBAN Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 3340 City, State, Zip SHELTON, WA. 98584 Installer Name Site Address 473 E CAPITAL PRAIRIE RD Designer Name CINDY WAITE INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑ Repair ❑other RFC �Z6 System Type Pretreatment Type 0 >5 ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA MYES >50 ft. from wells? - - - - - - - - - - - - - - - -RR rr�� 2I� M- - M ❑ Z >50 ft. from surface water? - - - - - - - - - - - 16-1><7-LS W-16- D 0 ❑ F Cleanout between building and tank? -- - - - ® ❑ V Tank baffles present? -- - - - - - - - - - - - - AUGf52OZ4 M ❑ d24" access risers over each compartment?- - - - - ® ❑ W Effluent filter installed?- - - - -- - - - - - - - f3 El El Septic tank capacity (working) al Manufacturer jD-box water level and speed levelers used? - - - - - - - - -- - - - - - ❑ N/A M YES ❑ No Manifold/D-box accessible from surface?- -- - - - - - - - - - - - - - - ❑ ❑ ❑ 9Z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - Transport Line Size W Schedule/Class Bedrooms installed (check one) ❑ 2 M 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ WA ® YES ❑ No >100 ft. from wells? - - ❑ M ❑ W >100 ft. from surface water? - - - - -- - ❑ M ❑ M >10 ft. from potable water lines? ❑ M ❑ 2 > 5 ft. from property lines and easements ❑ Q ❑ K > 30 ft. from downgradient curtain/foundation drains? N ❑ ❑ Drainfeld level and observation ports present - - - - - - - - - - - - -- ❑ M ❑ ❑ Graveless chambers or o Clean gravel used? (check one) Proper cover installed over drainfield?- - - - ❑ ® ❑ Pump tank setbacks consistent with septic tank? NIA ❑ YES ICI,No Y Pump tank capacity(flood) gal Manufacturer Q 24"access riser(s)and accessible from surface?- - - - - - -- - -- - - ❑ ❑ ❑ ~ a Alarm or Control Panel Installed? - - ❑ ❑ ❑ S Control Panel equipped with Timer/ETM I Counter ❑ ❑ ❑ 0- a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other ri Pump Make/Model ❑ Floats or ❑ Transducer 11� a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at uGde,ed t Mason County OSS Installation Report pg. 2 panel# 32008-42-90160 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - ❑ YES Q NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? ---- - - - - ❑ YES Q NO RECORD DRAWING This Is a permment raced and must be accurate and descriptive enough to relocate In me need of maintenance activltles and future development. Typcal Record 13mra ngs dented Draadleld&mandom o ienlNbn a layout Seprrlpump tank loulkn,North arrow,merve dm'm(e d,existing and proposed buildings,dr abor award wtledinea, wells ooserwatlon pores,cleanours,and other maintenance cocas points. Inromplele Radom Drawings may mesto somewhat delays ki Mel InTalletim approval and reletetl pvmib. I (V pY l�ad,t )Ira dvw. m S} rr 0 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 installed the system in accordance with 1 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/approvad 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 1 further call that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature)aIflnstaller Date Printed Nam of Signee 4000. MASON COUNTY PUBLIC HEALTH 3 1 The undersigned approves this lnst9a�lhation Rge��rt an A CWDY E.WAITS Nh Record Drawing on behalf of Ma of ed,rity Pl)blee `O LICENSED DESIGNER Health: y NNryFN 10jy `„d, ff ( 4 6' ��4DNMFNT Sig a u fEnvironmental Health Speci list Date Z4 (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updmaerz+rzgm M I c h � N � , AUG 2 6 2024 MASON CO""(ENVIRONMENTAL DJA r a a UN z N `MJA L W ^ T\ Q PPROVED DEC 0 6 2023 n b MASON COOM ENVIRONMENTAL M DJA HEAL7N �Ct •07 ®Q.0 of o ,� , � � moo � rncnaw iv .+ i• � 1.1 v�T � ¢� '. a � � � O -1 C7 -` AITI RI A 3mo♦ mo 'm xm omacm_ X v o m o o � $$ o � m Omm Q D..ny. m Z � O V � N a m m -UQ n -0 m a '� m - - � m N o afe. N � � m N N S 3I�I i.= rinted From Aason County DMIY-� Printed from Mason County DMS 1 I ' � I � . --R — — — i APPROVE 0 obsr �.� pw/ AUG 2 6 2024 Clr eu1�3 MASON COUNTY ENVIRONMENTAL HEALTH DJA ch t ° _V y„ y Ls APPROVED DEC 0 6 2023 7c ' MASON COUNTY ENVIRONMENTAL HEALT 1 "� DJA +� E. C 1 Sol EEWXE6441tl Printed From Mason County DMS Printed from Meson County DMS