HomeMy WebLinkAboutSWG2024-00411 - SWG As-Built - 3/24/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00411 Parcel# 22133-21-50003
Applicant Name Matthew Chamberlin Subdivision (Name/Dlv/Block/Lot)
Applicant Address 3180 E.Pickering Rd.
City, State, Zip Shelton,WA 985B4 Installer Name T-J. Gops
Site Address 1051 E. Pickering Rd. Designer Name Dale L.Tahla
INSTALLATION CHECKLIST
■Full System Installation ❑Tank(s)Only ❑Drartfield Only ❑Repair ❑Other
System Type Grevity Trenches P treatment Type
>5 ft.from foundation? -_____________ �T�Qr -- ❑WA ■YES ❑ No
>50 ft.from wells7 ---------- - (� \\tl\tl\ S�- ❑ ■ ❑
Z >50 ft.from surface wat;1 -- ---- �V - '�- ❑ ■ ❑
Cleanout between building and tank? -� �, - ----- ❑ ■ ❑
V Tank baffles Present? - _ ___ _____ ___ _ _-_ ❑ ■ ❑
F 24"access risers over each compartme --- -- --- - ❑ ■ ❑
W Effluent filter installed?. --------- -- ❑ ■ ❑
W 1,250 Val Manufacturer Hagerman
Septic tank capacity(working)
n D-box water level and speed levelers used? -------------- - ❑ WA ■ems ❑ No
OLL ManifoldlD-box accessible from surface?---------------- - ❑ ❑®
InZ Check valves installed? -------------------------- ■ El El
G� Transport Line Size 4 inch SdtedtlelgeY 3034
Bedrooms installed (check 0") ❑2 03 pp 6 ❑Commercial/Other
>10 R from foundation?---- -- -�- - ❑ NIA ■ YES ❑ No
>100ft.from wells?-------- y 2pz3 - ❑ ■ °
-� >100 ft.fro surface watei'1--- .0. -'
rL >10 ft.from potable water lines?- By EA�Rf1t14AFN7fk�HEALTt` 0 ® ❑
Z and eas� jov-_ ❑ ■ ❑
>5 ft-from property lines a 9fnla,�3
>30 ft.from downgradient curtain Moundation drains?---------- ❑ ® ❑
Drainfield level and observation ports present --- ----------- ❑ ■ ❑
■ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?-- ----------------- ❑ IN ❑
Pump tank setbacks consistent with septic tank?------------ - ❑ NIA ❑ YES ❑ NO
`L Pump tank capacity(flood) -gal Manufacturer
Q24"access riser(s)and accessible from surface?----- -------- ❑ ❑ Cl
F
d Alarm or Control Panel lnstatted? -----------------'-- - ❑ ❑
= Control Panel equipped with TimerIETM/Counter----------- ❑ ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ O6ter
IL Pump Make/Model ❑ Floats or ❑ Transducer
f
:3 Tank draw down in/min Pump rapacity apm Squirt Height ft
IL
Pump on time Pump oft time Daily flow set at apd
uPlaeL.,.,8
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MASON COUNTY ENVIRONMENTAL HEALTH
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APPROVE ®
MAR 2 4 2025
MASON COUNTY ENVIRONMENTAL HEALTH
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