HomeMy WebLinkAboutSWG2024-00367 - SWG As-Built - 11/1/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY
APPLICANT/ PERMIT INFORMATION.
Permit Number SWG Z02q- 00k3(o7 Parcel# LZoo 331/two II 2
Applicant Name SirvN SKIAIMSO— Subdivision (Name/Div/Block/Lo[
Applicant Address t'o SOX `j Zo By
City, State, Zip EAST ec�rlPiq-ruh `Yi N4 Installer Name SKWN£A-, fly � 9a
Site Address 191 £- A1uM1Ta• Iscawo PM- Designer Name rtw tk✓wr -A-
INSTALLATION CHECKLIST
❑ Full System Installation J?LTank(s)Only ❑Drainfiekl Only ❑Repair ❑Other
System Type IM SSSOXT— -rs Sppy IT`( Pretroabnent Type A114
>5 ft.fromfoundation? --------------------------- ❑NIA 13YES NO
>50 ft.from wails? ----------- ----------- ❑ a ❑
_ >50ft.from surface water? - - - - - -- --- --- - ---------. ❑ 19 ❑
Cleanout between building and tank? - _________. ❑ 19 ❑
V Tank baffles present? - -- --- - ------------- ❑ ® ❑
24"access risers over each compartment?--------------- - ❑ ® ❑
HEffluent filter Installed?---- --- - - -- - - ------------- - ❑ g El
Septic tank capacity(working)�250_ -_--gal Manufacturer Wr-if r-(LAR
1O0 D-box water level and speed levelers used? ----------- --- - aWA ❑YEB ❑ No
O Manifold/D-box accessible from surface?--- ------------- - ❑ B El`= Check valves installed? --- ----------------------- ❑ [�. ❑
'$. Transport Line Size ?-" Sctedule/Class. .�d
Bedrooms Installed(check one) 132 3 ❑4 ❑5 ❑S ❑CommerciaVOther
>10ft.from foundation?----- --------- ---- ----- ❑ WA ❑YEs ❑ NO
� . >100 ft.from wells?- -------- \��-��_?F ----- ❑ ❑ ❑
W ' >10oft.from surfacewater?----------------------- - ❑ ❑ ❑
>10ft.from potable water lines?---------------------- ❑ ❑ ❑
>5ft.from property lines and easements?--- ------------- ❑ ❑ ❑
>30 ft.from downgradient curtain/foundation drains?---------- ❑ ❑ ❑
Drainfield level and observation ports present - ---- --------- ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?----- - ---- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?--- -- - ------ - ❑ NIA M ❑ No
Pump tank capacity(flood) + —gal Manufacturer iu Gr i,}-ytaq"ro2
d. 24"access flser(s)and accessible from surface?------- ------ ❑ 19 ❑
6. ..Alarm or Control Panel Installed? -------- ------ -- ---- - ❑ ® ❑
Control Panel equipped with Timer/ETM/Counter----------- ❑ ® ❑
4 Pump installed in ❑ Bucket or ❑ On Block or Other $ASAP/
2 : Pump Make/Model cllJCAT Y Z¢o Floats or ❑Transducer
IL
n
Tank draw down Z in/min Pump capacity L gpm Squirt Heigh[ y /M ft
Pump on time /01r a Zd Sze- Pump off time J P- Daily flow set at ry e> apd
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Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of thle project? ------------- -- Cj YES jo NO
If yes, please describe:
Were all components pumped out and propedy abandoned per WAC246-272A-0300? - - - - - --- 0 YES NO
RECORD DRAWING
Tibia Is a pannana d mcoml and muse be aecnMa and desapnw mougn W re+pem In Me n«d of maintenance aodr&lea and Mum da.alapmena TmICaI Rx
Dmny6comain'. DAinflied L manimid oreangm&layout,SepndpYmp bank�,NBA anwe,m'ma dna"Mi coating and rm, ed WlMinga,IMAM domin wammines,
walla.Maervatlm pwb,tlmrwula,vd aNmmainlenanw armearyima. Imm�lgete Remd D2rAnpe meyaeale eddidonal dMeye in foal inalnXrim eppmval and Mond pMnits.
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I 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/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
1 further certify that all information contained on this 1 further certify that all information contained on this
foA7^and attached Record Drawing is accurate. form and attached Record Dm hg Is accurate.
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Signature of Installer Date fU_--Z
59:t-bI04-L SDI ABM C42— 'y -
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH s wart' r�sT
The undersigned approves this Installation Report and - eS-•
14MES t DE nK
Record Drawing on behalf of Mason County Public a iICENSEb btilc ig rR
Health:'� ^s-fir,` 1 I I E%P!hf5: 03/22/1.Ap
Signature of Environmental Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upuYa wvmta
s L—M 191 E NORTH ISLAND DR Service Company:
SHELTON
Tax ID:220033400011 Howdys Doody ServlCe Inc.
um Residential Single Family 62093rd Ave SE
Olympia,WA 98WI
(360)564-9936
Semiced:09/24/2024 by: Harrison Wood Submitted 09/27/2024 by:Darrell Smith
BieRecycfeg-Centrals Jurisdiction ID:220B33400011
COMMENTS
Pumpedfxdemo.
NOTE.THIS TANK WAS ONLY PAR I VM-LV SERVICED
Tank Pumped: YES
Tank Sias(Ga110ns)(Number only,no text): 1000
Effluent level within operational limits IN NO explain in comments):
Total Gallons pumped from lank(Number on ,no text): 600
Effluent returning back Into tank after pumping:
Tank depth below grade inches):
Access Risers installed to grade(N/A If not prosentp
Tank Construction Material:
Tank Condition Good;
Bafflas in goad condition(NIA if not present):
Effluent screen cleaned(N/A t not present):
Effluent surfacing around site commensals N/A if not checked):
Tank abandoned after pumping: YES
Were repairs made to me Tank or Tank Components?(IF YES explain in comments): NO
Compartment 1 Scum accumulation(Inches,t other specify): 0
Compartment l Sludge accumulation Inches,it other i 0
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