HomeMy WebLinkAboutswg2022-00003 - SWG As-Built - 11/15/2024 . 1
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANTI PERMIT INFORMATION
Permit Number SWG 2022-00003 parcel# 120313300010
Applicant Name Scott Webv Subdivision (Name/Div/Block/Lot)
Applicant Address 151 E Camus
City, State, Zip Shelton We 98584 Installer Name Shumaker Construction
Site Address 15f E Camus
Designer Name AP& Design
INSTALLATION CHECKLIST
■ Full System Installabon ❑Tarw(sl Only ❑Dmmfiekr OnlY ❑Repair
System Type Pressure ❑armor
Pretreatment Type
15 ft.from foundation? .--_- --------------------
N/A yes
>50 ft.from wells? ❑NO
Y '50 ft from surtace water? .__ ❑ ❑
■
r Cleanoul SeM'een building art 7 ._________________ . ❑ ❑
0Tank baffles present? ._____ _ _ _ -- ❑ ❑
a24"access users Over each comportment?-- -------------- ❑ ❑
Woff Effluent fitter installed?-__ _ __ _ ❑
Septic tank capacity(working) 1250 _a - Manufacturer ❑ • ❑
Norwesco
� D-box water level and speed levelem used? - - _ _
. UA ❑ YES
OO Manifob/D-box accessible from surtace?__ _ _ _________ _ _ _ ❑ uo
0< Check valves installed? - - -_ _ _ _ _ _ ___ _ ❑ ❑
E Transport Line Size 2 - _--- - -- - - - - ❑ ❑
9chadule/Class sch 40
Bedrooms installed(check mole) ®2 ❑3 ❑4 ❑5
>10 ft.from foundation?- --_ _ __ ❑6 ❑CommerrAal0 YE
>100 ft.from wells?- ❑ ryn res ❑ uo
Ij >100 ft.from surface wafer? .__�___
i '10 ft.from potable water lines?-_________________ _ _ _. ❑ ❑
>5 ft.from property lines and easemwgap ❑ : O
p >30 ft.from downgradient curtainRoundatbn draft?.____--__ ❑ .
Drainftb level and Observation pens prase, . - _ _ ____ __ ❑ ❑
0 Graveless chambers or ❑ Clean graval used? (check pre) ® ❑
Proper cover installed over drainftkl?.-----------______ _ ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?___________ 0 WA_
Y res ❑ uo
Pump tank rapacity(flood) 1250 gal kMrarksgrnr Norweam
!- 24"access nser(s)and accessible from surtace?--- ❑
IL Alarm or Control Panel Installed? _ _ _ _ _ _ _ _ _ _____ _ ❑ ❑
Control Panel equipped with Timer/ETM I Counter- -_ _____ El
Pump installed in [I Bucket or On Block or ❑ other ❑ ■ ❑
Pump Make/Model liberyl 280
BFloals or ❑ Transducer
IL Tank draw down 1.25 in/mn Pump capacity 'Z Q
opm Squirt Height 12 ft
Pump on time_ Fli.v Pump ofl ame q
Daily lbw set at,L_pd
uataaedlnou
F
on County OSS Installation Report pg. 2 Parceltl 120313300010
ABANDONMENTRECORDe o.aarg sepuc component abandoned as Panofoutpulsar+ -- - - - _ - YES ■
NO
s, please describee all components pumped out snd test"abandoned per WAC246472A.03007 -------. L3 we NO
RECORD DRAWING
aiwaai T,,l
bflemy p,nwyn me.veam aSwnN darns iv.nvylpupre .auaM mpba Ynm.Rs
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I cemty that l installed the system in acComence with I car*that the system has been installed in aCcor-
the septic design Stamped"APPROVED"by Mason dance wdh the septic design stamped"APPROVED"by
County Public Health and that any deviations shown Mason County Public Health and that any de Nations
here have been clearedrappmved by both the designer shown here have been cleared/Appmved by both
and Mason County Public Health and meet all State MYSta/f and Mason County Public Health and meet ell
and Mason County Codes. State end Mason County Codes
I further certify that all inlormation contained on this I)udhar that all inbmretion
form and attached Reco rawi is a curate. caddy rnntained I. this
C loan and attached Record Drawing is accurate.
l x
gneture or Insrartar Dale
_Agw in ch k
Printed Name of Slgnes y r
MASON COUNTY PUBLIC HEALTH u
The undersigned approves this Installation Report and PEPI NER
Record Drawing on behalf of Mason County Public
Health: �' S--Z y
Signature of Environmental Health Speci akst Dab
(stamp, signature and date)
THIS FORM MRY of SCMNED AND Avvu,,,.E Fqf pUaUC VIEW ON 1NE MASON COUNTY WEB SITE w.+a.aaaume
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APPROVED
FES 19 2025
MASON COUNTY ENVIRONMENTAL HEALTH
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