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Home My WebLink AboutSWG2024-00052 - SWG As-Built - 11/5/2024 Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00052 Parcel 32027-75-00120 Applicant Name TROY MORRIS Subdivision (Name/Div/Block/Lot) Applicant Address 2027 FERRY STREET City, State, Zip SHELTON, WA. 98584 Installer Name 1✓yzt- a .. Site Address 350 SE CERMAK LANE Designer Name CINDY WAITE INSTALLATION CHECKLIST J9 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pretreatment Type >5 ft.from foundation? --------- M - ❑ ern VYES El NO 150 ft.from wells? - --------- - ❑>50 ft.from surface water? --- ---Cleanout between building and tank?Tank baffles present? - - - - - - --- . ❑ n/ ❑24"access risers over each compartm - ❑ ❑ rW Effluent filter installed?- - --- -- -- --- -- --- ---- ------ ❑ ❑ Septic tank capacity(working) 12f n gal Manufacturer R-44 o D-box water level and speed levelers used? -- -- -- ❑ NIA BYES ❑ No gO Manifold/D-box accessible from surface?- - - - -- -- - -- -- -- - - ❑ [� ❑ GOz Check valves installed? - - - - - --- - -- - - - -- - --- - -- --- ❑ ❑ 04 f Transport Line Size ylv Schedule/Class 7 y Bedrooms installed(check one) ❑ 2 ❑3 �4 ❑5 ❑6 ❑CommerciaVOther >10ft.from foundation?--- ------ -- - ---- ---------- /A 9YEs ❑ NO >100 ft. from wells?---------------- - ------------ [[(� ❑ W >100 ft.from surface water?---------- -- ------------ ❑ X >10ft.from potable water lines?------ ---- ------------ [� ElQZ > 5ft.from property lines and easements?--- --- ---------- ❑ a > 30ft.from downgradient curtain/foundation drains ❑ Drainfield level and observation ports present - - - - - ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?---- - --- ----------- ❑ U/ ❑ Pump tank setbacks consistent with septic tank?-- ----------- _ •A - 3 [�O ZPump tank capacity(flood) at Manufacturer 4 24"access risers)and accessible from surface?----- ---- -- -- _ 0 ❑ yAlarm or Control Panel Installed? ---- - ----- ---- - ------ ❑ ❑ i Control Panel equipped with Timer/E7M/Counter------ - -- - - = ❑ ❑ it Pump installed in ❑ Bucket or ❑ On Block or ❑ Other C Pump MakelModel ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity apm Squirt Height ft Pump on time Pump off time Daily flow set at opd y upe.Na erz/rzo/s N�✓+� � 22�^lia.. Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - --- -- - -- - YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? ---- --- - ❑ YES NO RECORD DRAWING This b.wralaMnr nwN and Thin W.counts and GbctlpM.enough to re.louu in the Na or maintenance.tile:and Mum chwa oMent. Typical Record Drawings contain: Dremfield a menilold onentaeon a dyout.sepaupump mnx io Wn,NoM anmv,reserve dremfua,adding and propo ed du Wings oration orweui,.wate,,raw. walla,onande wl pods,dr anoud,and other maintenance suer points. Incomplets Record Drawings They creole additional delays in final linger mini approval and related permits. li fNr/ti Qj d vu r'/J2 dvq_r- CA' g 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 1 further certify that ail information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature oflnatellerO Date Printed Name of Signee k3 MASON COUNTY PUBLIC HEALTH - �.. J. The undersigned approves this Installation Report and a 51 E I tTE Record Drawing on behalf of Mason County Public LICEaSBD oFsteMdR Health: uwRes,mid Signature of Environments/Health Specialist Date (stamp,signature antl date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upaatse ntngta S a 10,40 53bldx3 WO, N1� �aL tlalry 3036N3]�cll i NOV� MASOHCOUHry Hh2 RfT HM ' T HEALTH i C i . . .!. .. .................................. tA n e ` $ t \ k \ y r � ' Z v� �y,.• o � i � N .Wb4 so' ------------- "z DL mf.uk APPROVED Q MAR 2 2 2024 MASON COUNTY ENVIRONMENTAL HE4131+ RET ateeuol4E. pnNr 4g MENBEO UES XR , EMNNEB OSt6 i 94 APPROVED- NOV 12 2024 MASON COUNTY ENVIRONMENTAL HEALTH RET