HomeMy WebLinkAboutSWG As-Built - 12/6/2024 -I (+ffy +it& Tacit- 45huo f w/ feser ve, Aa;nf,`e4wY-
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG Parcel# 32006-50-02073
Applicant Name TRAVIS/DAWN TWIDDY Subdivision (Name/Div/Block/Lot)
Applicant Address 121 N ENATAI CT iwgner
City, State, Zip SHELTON WA. 98584 Installer NameSite Address 1910 E,:Z; -+CcDR Desi Name
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INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type nn���y❑n Pretreatment Type
>5 ft.from foundation? -------- - Epp �, Ir ',1 C' - ❑ WA NYES ❑ No
>50 ft.from wells? ----- ----- - 15-L"-1�i-J- - -- - ❑ e ❑
Z >50 ft.from surface water? - ------ -o- ZBYk- El ❑
FQ- Cleanout between building and tank? - ----- - ------ ❑ ❑ ❑
tj Tank baffles present? - - -- - - - - - - -- - ------ ❑ ❑ ❑
C 24"access risers over each compartme By -- ------- ❑ ❑ ❑
W Effluent filter installed?- -- -- - -- - - --- -- ------ -- ---- ❑ ❑ ❑
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Septic tank capacity(working) 750 gel Manufacturer EXISTING
0 D-box water level and speed levelers used? --- - - --- -- --- - - ❑ WA ❑vas ® NO
Otl.
0 Manrfold/D-box accessible from surface?------ --------- -- ❑ ❑ El
09= Check valves installed? -- - -- - - ------------------- ❑ ❑ ❑
O
Transport Line Size Schedule/Class
Bedrooms installed(check one) E 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commerclai/Other
>10ft.from foundation?-------------------------- ❑ INA ® yes NO
G >100 ft.from wells?- -- -------------------------- ❑ ❑
W >100ft.from surface water? ------------------------ ❑ ❑
LL >10ft,from potable water lines?---------------------- ❑ ® ❑
? > 5ft.from property lines and easemenis?-- -------------- ❑ ® ❑
>30 ft.from downgradient curtainlfoundation drains?---------- 0 ❑ ❑
Drainfield level and observation ports present - - --- ❑ ❑ ❑
❑ Graveiess chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfeld?- -- - --------------- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?------------- ❑ WA ❑ YES ® NO
M Pump tank capacity(flood) at Manufacturer
Q 24"access riser(s)and accessible from surface?------------- ❑ ❑ ❑
F
y Alarm or Control Panel Installed? --- - -- - - - - -------- ---
❑ ❑
Control Panel equipped with Timer I ETMf Counter- ---------- ❑ ❑ ❑
iL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
d Pump Make/Model ❑ Floats or ❑ Transducer
f
:5 Tank draw down in/min Pump capacity apm Squirt Height ft
A.
Pump on time Pump off time Deily flow set at gpd
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Mason County OSS Installation Report pg. 2 Parcel 4 32006-60-02073
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? ----- ---- - -- --- ❑ YES ❑ NO
If yea, pease describe:
Were all components pumped out and property abandoned per WAC246s272A-0300? -- - -- - - - ❑ YES ❑ NO
RECORD DRAWING
Thk a a permanent raennd..it must W aeeunto and Enetlpswe enough to a hands In the need of melnunanea adlvltba and inure development. Typiml Recom
pavnrpre contain'. Oreinfi¢YJ 8 menilok ooM184on fl IaypW.$epflrlpump lank IOmMn.NMh enox,reserve orainlelq e.¢ting anG propoaetl oullElnpa.ImEon M welb,wetedines.
wNls,OCurvalion pMs,tleermuLL,aiM tiller meinlenarrce access pdnb. In,ompa,R¢m0 pawing,may uad,additional delays in final maralYdon approval and deleted tennis.
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNEW 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 end that any deviations shown Mason County Public Health and that any deviations
here have been clearediapproved by both the designer shown here have been clearedrapproved 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 Record Drawing is accurate. form and attached Record Drawing is accurate.
Signature of Installer Date
Printed Name o/Signee
Y
MASON COUNTY PUBLIC HEALTH RL" e� 8 1
The undersigned approves this Installation Report and �` CINSND' E.wnnE
Record Drawing on behalf of Mason County Public LICE E ESM.NEa
Health' Expaddi Duna
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLICVIEW ON THE MASON COUNTYWEBSITE upmtad vnrmte
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