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Home My WebLink AboutSWG2023-00120 - SWG As-Built - 9/26/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 20 -00120 Parcel # 32024-12-90061 Applicant Name JENESSA OMOAHL Subdivision (Name/Div/Block/Lot) Applicant Address 100 E EMILY LANE City, State, Zip SHELTON, WA. 98584 Installer Name MAX OMDAHL(SELF INSTALL) Site Address 100 E EMILY LANE Designer Name CINDY WAITE INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type PRESSURE DIST Pretreatment Type >5 ft.from foundation? ----- --- ----------- - ---- - -- ❑ N/A YES ❑ NO >50 ft.from wells? - - -- - -- --- --- -- --- -- - - - - - - - -- ❑ ❑ Z >50ft. from surface wateR -- --- - - - - - ---- - - - - ---- - - ❑ ❑� ❑ FCleanout between building and tank? - ------- - --- - - ----- ❑ ❑ U Tank baffles present? - - - - - - - - ------- - ----- - - - --- ❑ � 24"access risers over each compartment?-- -- - - - - - -- -- -- - ❑ ® ❑ o ❑ ® ❑W Effluent filter installed?- --- --- - - - -- - - --- -- - - - -- - - - to Septic tank capacity(working) 1200 gal Manufacturer SOUND PLACEMENT 0 D-box water level and speed levelers used? ---- - -- -- -- -- - - N/A ❑ YES E] NO p0 Manifold/D-box accessible from surface?- - ---- - -- ----- - - - ❑ El mZ Check valves installed? --- - - - - -- - - - -- - - - - - - --- -- - ❑ ❑� ❑ 04 2 Transport Line Size 2' Schedule/Class SCHEDULE 40 Bedrooms installed (check one) ❑ 2 a _❑www4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?----- - -- �/1p'�� - [] N/A ® YES E:] NO 0 >100 ft.from welts?- - -- ------ ------ E 0 ❑ -ULLJ >100 ft. from surface water?----- --SER1g- ® ❑ Z >10 ft.from potable water lines?---�ASONLpg .l,�V//R0N rK4__ ❑ ® ❑ > 5 ft. from property lines and easements?- - ---(p UU�At/7fA/T ❑ ® ❑ W > 30 ft. from downgradient curtain/foundation drains?' - - - - - - H e ❑ ❑ Drainfield 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?-- ---- - ------ ❑ N/A ® YES ❑ No Y. Pump tank capacity(flood) 1275 gal Manufacturer SOUND PLACEMENT Q24"access riser(s)and accessible from surface?-- ----- - ---- - ❑ ® ❑ II"l ~ Alarm or Control Panel Installed? ---- -- - -- - -- - - ------- ❑ ❑ -1 a ❑ ❑ � Control Panel equipped with Timer/ETM/Counter-- -- - - - - - - - EL Pump installed in ❑ Bucket or ® On Block or ❑ Other 1L Pump Make/Model LIBERTY 250 ■ Floats or ❑ Transducer f y Tank draw down 1.25 in/min Pump capacity 27.95 opm Squirt Height 2 ft Pump on time 1 MIN 36 SEC Pump off lime 4 Daily flow set at 270 gpd up08110 BRIM. Mason County I Installation Report pg. 2 Parcel a 32024-12-90061 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - -- - ❑ YES (] NO If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? - - - - - -- - ❑ YES ❑ NO RECORD DRAWING This Is a pannnwd record and must bat accurate and deacripdae enough to re-locaY in the need of mallesdanca edirelaa and Mum deeemmasset Trader Renard came,domain: Dmircrold a mammm orientation a uyam sandupamp lank adenine form ai reel dresseid e.rseng and propmed buildings.laddron of stela wwnedlpes. stelae,obwrvalkm Dprls,aeemW.and aner mnnlenance dodge poinle Inmmplele RenaJd Drawings may drea+e additional delays in anal msla ff on appnwal and relattd planes. arf J!/roll Tau I LC d wiv In,' dr� PPROVE SEP 2 6 2024 Lf VASON COUNTO ENVIRONVENTAL HE4LThl JBW 0 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 form and attached ecord of ing is accurate. form and attached Record Drawing is accurate. Signatu of Installer Date 174, 1-Y L Printed Name of Signee MASON COUNTY PUBLIC HEALTH s+ooa+e /,1 CINDY E.WAITE ' 3 The undersigned approves this Installation Report and LICENSED DESIGNER Record Drawing on behalf of Mason County Public r.mRLs us�Id� He avy, 0 1, ,yo-�— 1-z�•�Y �I�I Sign ore 6UIivironmenti Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upaaled e12112md ry ---- - --- ------- --- --------- - ti a°o°�J JO ry 4 � c n � !0 _0 --------�---- --------- --- - __..._._ ...a. . w mom F f LL W W W aaza zaps NjK W ein h r3Wao orc w �+ � W GIYQ� ¢ N � Z f E ^ oo wU U2 � FQZJJ WZZ 8 OO - c somry c V on W W OINyf -D 4.e Lea` 6 ' r s 3rr 24" G�7oe CJI L Y, I �C�70w I I 12 VS rvu SGah P Ll EIPIRES OS'lN N1