HomeMy WebLinkAboutSWG2024-00143 - SWG As-Built - 9/18/2024 Mason County OSS Installation Report pg, I
APPLICANTS PERMIT INFO MASON COUNTY PUBLIC HEALTH
H
Permit Number SWG 2024-00143 RMATION
Applicant Name DAVID Rossl Parcel# 12019-32-90020
APplicantgddress 193 E POINT WILSON RD Subdivision (Name/Div/BIccWLot)
City, State, Zip SHELTON, Wq,
11 Sitegddress 98584 Installer Name
4193 E FOUNT WILSON RD SELF INSTALL
Designer Name CINDY WAITE
® Full System Installation INSTALLATION CHECKLIST
❑Tank(s)Only
System Type PRESSU ❑Drainfield Only El Repair
>5 ft from RE )IST ❑Other
foundation? ._ Pretreatment Type
>SOft. from wells? w _ __ _ _ __ _ _ __ _ _ __ _ _ __ _ _ _ _ _ .
Y >50 ft. from - ❑WA
surtace water? _ ❑ ®YES ❑ NO
F„ CleanTank
b ut be
hveen building and tank? - _ _ ___ _ _ _ _ ____ __ _
F Tank babies present? - _ _ _ _ _ - ❑ ® ❑
d 24"access risers over - - - - - - - ' - - __ _ _ ❑ ® ❑each compartment?- _ _ _ _- ❑ ❑y Efiuent filter installed?._ _ _ _ _
Septic tank capacity(working) 26-1 ❑ ® ❑
D-box water level ands 1-gal Manufacturer ❑ ® ❑
Manifold/D-box a Pead levelers used? - _ _ - _ _ - HAGERMAN 1250
to ccessible from surfs o i Check valves installed? - _ _ _ _ - -surface? _ - - - - ®wA ❑YES
Transport Line Size ❑ ® ❑ No
Schedule/Class SCHE- ❑
Bedrooms installed (check one
>10 ft. from foundation?. _ _ _) _ 0 2 ®3 ❑4 ❑5
io >100 ft. from wells?__ _ __ _ _____ _ _=___ ❑8 ❑Commercial/Other
>700 ft. from su - ❑ NIA W dace water?- _ ___ _ __ _ _
❑ ® YES ❑ NO
Z 10 - ito.�potable water lines?-_ _ _ _ _ __ _
Q > 5 ft. from property lines and easements?- _ _ _ _ _ _ __ _ _ _ _ _ _ - ❑ ® ❑
p >30 fi from downgradient curtain/foundation drains?- _ _ _ _ _ ❑ ® ❑
❑Drainfield level and observation ports present - - _ _ _ _ _ _ _ _ ❑ ® ❑
Graveless chambers or ❑ ❑
Proper cover installed over drain❑fle glean gravel u ❑sed? (check one) ❑
Pump tank setbacks consistent with septic tank?- - - - -- - - -
St - -_- ❑= PUMP tank capacity(flood) 1485 ❑
F- 24"access hser S ��gal ❑ NIA ® YES( )and accessible from surface? Manufacturer ❑ No
4 Alarm or Control Panel Installed? - __ _ _ _ _ ❑ HAGERMgN 1250
z Control Panel equipped with Timer/ ❑
)(Purr in ETM/Counter- - - - - -
I ❑P stalled in Bucket or ❑
PumP Make/Model f` �On Bl ❑
ock or ❑ I , rN�® ❑
IL Tank draw down 75 ❑ Floats
Pump on time 2 '^/min Pump capacity 17 or ❑ Transducer
Pump off time- �9Pm S4uirt Height 27ft
v
Daily now set at 275.
�9Pd
Mason County OSS Installation Report P9. 2
Parcel# 12019-32-90020
Were existin ABANDONMENT RECORD
8 "Ptic components abandonatl as If Yes, please tlescribe: Pan of this Projeco . _ _ _
Were all comPonents um _ _ _ _ __ _ _ - ❑ YES o NO
Pumped out and properly abandonetl per WgCpgfi272A-03007 - - ___ _ _
YES NO
ThN Is<pmmenent rxoN entl mMt b RECORD DRAWING
nrtmn0<Cm<In: n <6CYr<N<IIO d..."pa.In m In NB MN10f melmm�<MI iCrlVll
raulfeb6 mylROp OMnlalgn 6l¢ OUOM1 to n-oc
welN,OOMrvmpn Pon< y<enON<,gnd OVIN melnl<nanM acc<ae�Wmp NnX loylion.NorM<rroy regerv<ORmrgltl,<yi<liiy 9ny <n0 future tlwele
PoM�B. ncnmpbl<flemrd Pment Typical Remm
nrawNyl m<Y c+e<la adtlhlm<IdnNYe In fn I�y1pN'I^� I.Ol walla.wal<rinBe,
pOrovel and relabel p<rmll<.
1110
d�fffI.;
*Record Drawing Attached
INSTALLER CERTIFICATION OF INSTALLATION
I certify that installed the system in accordance with DESIGNER(ENGINEER
the septicmy P design stamped`APPROVED"b I certify that the system has been installed in accor-
County public Health and that any deviatio^s�how�
-dance with the septic design stamped'APPROVED-by
here have been c%arad/approved by both the designer
Mason County Public Health and that any deviations
and Mason County Public Health and meet all State shown here h
and Mason Count C have been County
Public
Ha.ved by both
Y Odes. mate/f and Mason County Pubs Health entl meet a//
l further codify that all information State and Mason County Codes
forma d attache contained on this
he ecord�g is accurate. I further certify that all information contained on this
/ \ form and attached Record Drawing/s accurate.
S/gneturacflnste//er 2:i
Date
Printed Name of signce
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and ep
Record Drawing on behalf of Mason County Public
IVA
Health: ENSI WADE R
UCEN�pESIPNEfl
ExRRES. Im � �:A
gnature orEnVtmnmental Hea/th Speaalrst
Date
(SISMA
THIS FORM"Ay BE SCANNEDANDAVAILABLE FOR PUBLIC VIEW ON THE MASON CgOUNTY and date)
WEB SITE cpdBNd sn+rzole
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1 N a r MASON CO EP 18 1014
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