HomeMy WebLinkAboutSWG2025-00052 - SWG As-Built - 4/7/2025 1�c�uIS-ed �UIVT
Mason County OSS Installation Report pg. 1 —1VIASON160OtiNTTPMLIC,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 "Lt ., C..J/
Site Address 350 BE CERMAK LANE Designer Name CINDY WAITE
INSTALLATION CHECKLIST
34 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pretreatment Type
>5 ft-from foundation? ---------*fi Fi-- ❑wA W "' ❑ No
>50 ft.from wells? - ---------- I'111�. IyIJ}I - ❑ �. ❑
thl�Jlryl
2 >50 ft.from surface water? ------�i� - ❑ ❑
H Cleanout between building and ton kT .�Jk flbV D _ 24 ❑ �, ❑
tl P "__- ------- _ El IV
❑Tank baffles resent? - - - - --- - -
11.
24'access risers over each oompartmenti- -- ❑ ❑
NEffluent filter installed?- -------- ----------------- - El [all El
Septic tank capacity(working) 12rri del Manufacturer_�+�
O D-box water level and speed levelers used? - ------------ - - ❑ WA 9 s NO
OJ
LL Manifold/D-box accessible from surface?-- - -- -- -------- - - ❑ a ❑
m Check valves installed? --- ---- - - --- ---- - -- -- - -- - - [(� ❑ ❑
ILI
f Transport Line Size !Ev Schedule/Class 307�
Bedrooms installed (check one) ❑ 2 El3 Lql 4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?--------------------- ----- IA 21 es ❑ NO
>100ft.from wells?-------------------------
J >100 ft.from surface water7------------------------
LN ElW [al ❑LL >10ft.from potable water lines?----------------------
aZ >5ft.from property lines and easements?---------------- 93/ ❑
C' >30 ft.from downgradient curtain/foundation drains?--- -- --- - - ov ❑
Drainfield level and observation ports present -------------- ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Propercoverinstalledoverdrainfield?------------------- ❑ ❑
Pump tank setbacks consistent with septic tank?------------- - ,_ •A .. _; t No
14 Pump tank capacity(flood) Oal Manufacturer
G24"access riser(s)and accessible from surface?------------- _ ❑ El~ Alarm or Control Panel Installed? -------------- ------- ❑ ❑ I
a =,
� Control Panel equipped with Timer/ETMI Counter----- ------ ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
d Pump Make/Model ❑ Floats or ❑ Transducer
2
a
Tank draw down in/min Pump capacity ppm Squirt Height ft
Pump on time Pump off time Daily flow set at Opd
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this projed? ----------- - --.
If yes, please describe ❑ YES NO
Were all components pumped out and property abandoned of per WAC246272A-p300? ------- - ❑ vas No
RECORD DRAWING
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aord and must ad..came and d aaalptive anaugrl tp rt locate In Ne need 0 malatananca saNaes and M1 m detelepmam. Typical RemM
Nd 8 manifok orlema0on&layom Senfi�hump tank loutan.NOM ano ,,reserve OM ftdd,adding and propased NAdings.lopdan ofwalla,w Winas,
oeanp^and doer marnnanceac,,ss pain. Incomplete Wcord Drawings may ueae addldwaldd.p N rural ins&diacan appmval and Matedp anaad,
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I Certify that/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 cleafedlapproved by both the designer shown here have been c/earedepproved 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
Primed Name of Signee
t VVV
MASON COUNTY PUBLIC HEALTH � ' i € - 3�
The undersigned approves this Installation Report and ON 51 ' T 'h l
Record Drawing on behalf of Mason County Public Lac sEo oFslc�riER - '
Health:
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Waeeantrmte
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Nov 12 2024
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