HomeMy WebLinkAboutSWG2024-00279 - SWG As-Built - 11/5/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT(PERMIT INFORMATION
Permit Number SwG 2024-00279 Parcel # 22018-53-00019
Applicant Name ARTHUR VAN VEEN Subdivision (Name/Div/Block/Lot)
Applicant Address PO BOX 662
City, State, Zip SHELTON WA. 98584 Installer Name atr T
Site Address 2381 E TIMBERLAKE WEST DR Designer Name CINDY WAITE
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type 4 2N Vl-Q— Pretreatment Type
>5 ft.from foundation? ---- --_ _
Z >50 ft.from wells? . --- --- -_ _ _-- -- - - -- - - -
Septic Oxrn �YEs ONO
>50 ft.from surface water? - ___ _ _ ❑
F Cleanout between building and tank? ❑ e. ❑
U Tank baffles present? - --- - - - - - _ - ❑ ❑
a24"access risers over each compartm _: O r�} ❑
rW Effluent filter installed?- -- -- -- - - - _ __ _ ❑
Septic tank capacity(working) (2-.Cu at Manufacturer ti
OO D-box water level and speed levelers used? -- - -- - - -- - - -- -. WrNIA ❑YES ❑ NO
u Mantfold/D-box accessible from surface?-_ __ _ _ _ _ _ _ __ _ _ _ _ . ❑ ❑ Q�
GZ Check valves installed? -- - -�_ _ __ __ __ _ _ _ _ _ _ __ _ __ _ _ ❑
Transport Line Size 7/ Schedule/Class
Bedrooms installed (check one) ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.fromfoundation?- _ _ _ _ _ _ _ _ _ ___ __ _ , ❑ con DYES NO
G >100 ft. from wells?- -- -- -- - ---- --- -- --- - -- - -- - - -- ❑ ❑
W >100 ft.from surface water?--- - -- -- -- -- - -- --- -- - -- -
❑ ❑ ,_,/
ad
Z >10ft.from potable water lines?- _ _ __ _ __ _ _ _ _ _ _ _ __ __ _ _- ❑ ❑
>5ft from property lines and easement,?- - - - - --- ---- - - - - ❑ �. - ❑
> 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 drainfeld?---- - -- - --- - - -- - - -- ❑ �. ❑
Pump tank setbacks consistent with septic tank?----- - --__ _ _ . ❑ Nu trT YES ❑ No
2 Pump tank capacity(flood) (.,4� at Manufacturer
F24"access dser(s)and accessible from surface?-- - ---- - ---- . ❑ ❑
S Alarm or Control Panel Installed? --- - - - - - -- -- -- - -- - - -- ❑ 2 ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - -- -- - ❑ ❑
d Pumpinstalled in ❑ Bucket or 0 On Block or ❑ Other l'q
IL Pump Make/Model i-6 o L Floats or l� °, >� ❑ Transtlucer
C Tank draw down liNmin Pump capacity .SO. 76 opm Squirt Height 2�11
Pump on time . Sr(r4, Pump off time Y Daily flow set at /�gpd
upeeueWwO18
Mason County OSS Installation Report pg. 2 Parcel It
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ----- -- -- - - - . g YES No
If yes, please describe:
Were all components pumped out and property abandoned per WAC248-272A-0300? ------ - - to YES 0 No
RECORD DRAWING
mla Ia a Perinan.nt rewM.n0 mun Oe aeaaa nd enceplN....on w re.l«na in ma nN of maiMnunOv aMrltln and M.n eera0 p w,Ns wnaln'. Damfi¢Id 8 Tenllok OMnatiOn 81e pnlanl. Typical RewM
ym S s pump bnk Iou RNOManaw,Msarvacmtead tonaidendpM«.adO liawn ppa iamml wabnlnaa,wNl.,ap9dlveM1on poN,GaanOub,aM OIMt m.inanenw esme poinb. Incomplea geWM prewinpe may Create etleiM1onal delays in find inelellaYon
// OPayal aM reatW pemiia.
-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 actor-
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 Geared/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 ell information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate-'
Signature of Installer Date
ALC4ENSEDDES�IER
Printed Name of SigneeMASON COUNTY PUBLIC HEALTHThe undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health' LxnRca.av+a
f l2(uf P
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE .1771
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NOV 12 2024 APPROVED
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