HomeMy WebLinkAboutSWG2024-00453 - SWG As-Built - 12/13/2024 a
Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH
APPLICANTI PERMIT INFORMATION
Permit Number SWG 2024-00453 Parcel # 32005-50-00005
Applicant Name Jason Webber Subdivision (Name/Div/Block/Lot)
Applicant Address 42 E. Hemlock Ct. Oak Park Div.2 Lot 5
City, State, Zip Shelton,WA 98584 Installer Name Weather Tight Const.
Site Address 40&42 E. Hemk)&Ct. Designer Name Dale L.Tahja
INSTALLATION CHECKLIST
[] Full System Installation ❑Tank(s)0rdy ■Drainfield Only ❑Repair ❑Other
System Type Gravity Bed Pretreatment Type wA
>6ft.from foundation? --------------------------- ❑wA EYEs ❑ No
>50 ft-from wells? ------------ Elpf,=r1�� ❑ e
Y >50 ft.from surface water? - ------ E5:11.=a� ❑ ■ ❑
r Cleanout between building and tank? -- - & ❑ ■ El
U Tank baffles present? --- -- ----- ---- ----- ❑ ■ ❑
F- 24"access risers over each compaMren' -- - ------- ❑ ■ ❑
W Effluent filter installed?---------- -y ❑ ■ ❑
f/1
Septic tank capacity(working) 1.500 ael Mererlecturer (Existing)2-750 gal.
O D-box water level and speed levelers used? -------------- - ❑ wA EYEs No
❑
DO Manifold/D-box accessible from surface?---------------- - ❑ ® ❑
ogZ Check valves installed? ----- --- ------------------ ■ ❑ ❑
CQ 3034
f Transport Line Size 4 inch Schedkda/Ckw
Bedrooms installed(check one) ❑2 ❑3 ■4 ❑5 ❑6 ❑Commercall0ther
>10R from foundation?-------------------------- ❑ NIA Eves No
>100 ft.from wells?----------------------------- ❑ ■ ❑
J >t00R from surface water? ----------------------- - ❑ ■ ❑
W
ILL >10ft.from potable water lines?- -------------------- - ❑ ■ ❑
ZQ >5ft.from property lines and easements?---------------- ❑ ■ ❑
OC >30 ft.from downgradienl curtain/foundation drains?--------- - ❑ ■ ❑
Dminfield 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?------------ - ■ MIA El YES ❑ No
ZPump tank capacity(flood) gal Manufacturer
Q 24"access dser(s)and accessible from surface?------------- ❑ ❑ ❑
o~. Alarm or Control Panel Installed? ----------- ❑ ❑ ❑
2 Control Panel equipped with Timer I ETM I Counter----------- ❑ El
0- Pump installed In ❑ Bucket or ❑ On Block or ❑ Other
IL Pump Make/Model ❑Floats or ❑Transducer
6 Tank draw down in/min Pump capacity gum Squirt Height ft
Pump on time Pump oR time Daily flow set at gpd
uoa.m arskrzore
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Mason County OSS Installation Report pg. 2 Parcel#33005 ' SC-Q'�,(`l�J
ABANDONMENT RECORD
Were existing septic components abandoned as pan of this project? ------ --------- YEa ® No
If yes, please describe:
Were all components pumped out and property abandoned per WAC245-272A-0300? -------- YES 0 No
RECORD DRAWING
TI�b b r Pa�aa�aN wE nLL b emneb aM iWOaw�nwel b_. . " N e�nw0 d esYYrre 61Man aq aM YMbMnMI lyrly PaaJ
4aNNe mnleln: eroYflra 6 neNfotl ulOnbAd1 A byM,SaplUip,�rybnlb6eon,lots amw�uwravYaW.®YaN mH O�baigr.loratlui N'wr4 mbkea.
x'eY.oNwgman pwK fYuwb.W aa,e�mri,Wercnaca'es ruK MmnOUe�tl orerNrnnr� deYf'<hlbal Ng VYm�YPO'wl M RIYtl Yam
® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
l certify that I installed the system In accordance with l certify that the system has been installed in accnr-
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 ceared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Heath and meet all State mysat and Mason County Public Heath and meet elf
and Mason Comfy Codes. State and Mason County Codes
l furthercertty that all information contained on this l further cattily that all information contained on this
Rum and attached RecprdD wing is acc to form and attached Record Drawing is accwate.
ySigns m o/ Date �
Printed Name of Stgnse
:dt
MASON COUNTY PUBLIC HEALTH % ^J k t
The undersigned approves this Instal/at eport sl/d O 5 5100214 fr
Recercl Dmwfng on behat of Mason Coun;j 11- Dab I.Tahje
Heatl,^ 7 NryFN� 44 `O LICENSED QKSIGNER
4 N
Signature of EnvLonmenta/Heats Specialist Date lA<HF (stamp, sign,Wre and dale)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBDC VIEW ON THE MASON COUNTY WEB SITE uiE B 16
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APPROVED
U DEC 13 2024
.� MASON COUNTY ENVIRONMENTAL HEALTH
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