HomeMy WebLinkAboutSWG2024-00052 - SWG As-Built - 4/7/2025 1�c�uIS-ed jUIVT
Mason County OSS Installation Report pg. 1 -1VIASONCOUNTYPOgtIC,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 "LEna., C.,S
Site Address 350 SE 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 - - ❑wA W "' ❑ NO
>50 ft.from wells? - --
-
------- I'111�. IyIJ}I - ❑ �. ❑
thl�Jlryl
2 >50 ft.from surface water? ---- ❑ ❑
Cleanout between building and tank? .�Jk flbV D _ 24 ❑ �, ❑
V P ❑ W ❑
Tank baffles resent? - - - - --- - - "
a24°access risers over each oompartme -- ❑ ❑
W Effluent fiilter installed?- -------- ----------------- - ❑ I� ❑
U)
Septic tank capacity(working) 12rr> aal Manufacturer r$4
O D-box water level and speedlevelers used? - ------------ - - ❑ N/A [B'YEs 0 N
OJ
LL Manifold/D-box accessible from surface?-- - -- -- -------- - - ❑^/ a ❑
mz Check valves installed? --- ---- - - --- ---- - -- -- - -- - - I!d' ❑ ❑
0<
N Transport Line Size 4t, Schedule/Class 3074'
Bedrooms installed (check one) ❑ 2 ❑3 L'4 ❑ 5 ❑6 ❑CommerciavOther
>10ft.from foundation?--------------------- ----- IA fives ❑ NO
>100ft.from wells?-------------------------
>100 ft.from surface water7------------------------
W LN ❑Ial ❑
LL >10ft.from potable water lines?----------------------
kfr
aZ >5ft.from property lines and easements?---------------- ❑
>30 ft.from downgradient curtain/foundation drains?--- -- --- - -
0
Drainfield level and observation ports present -------------- ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Propercoverinstalledoverdrainfield?------------------- ❑ ❑
Pump tank setbacks consistent with septic tank?------------- - ,_ •A
14 Pump tank capacity(flood) gal Manufacturer
Q24'accessriser(s)and accessible from surface?------------- _ ❑ ❑
~ Alarm or Control Panel Installed? -------------- ------- ❑ ❑
a
2 Control Panel equipped with 7mer/ETMICouMer----- ------ ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or O Other
d Pump Make/Model ❑ Floats or ❑ Transducer
2
Tank draw down in/min Pump capacity pm Squirt Height ft
Pump on time Pump off time Daily flow set at asaOpd
-T Upd&?roam
, J Nor 2TJ'��>n
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? ----------- - ---
If yes, please describe: ❑ YES NO
Were all components pumped out and properly abandoned per WAC246272A-p3oo, ------- - ❑ vas D NO
RECORD DRAWING
miss a permanent record and must ad accurna and e aaalpyecdpom enough to n.bosh In the need of maintenanu and pro and NNre development a am. Typical Record
Omtiilgs contain: 0raiMNd8manimk orlema0on&layom Senficnump tank loutan.NOM snow,resatve On ftd.wining and proposed NAdings.logtian ofwalla,w Winas,
walls,observation ports,, oeanouts,and dyer maintenance ac N rural ss points. Incomplete Record Drawings w may create addldonal delays al installation approval and related permits,
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&Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/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 and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved 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 of Signee
t VVV
MASON COUNTY PUBLIC HEALTH .
The undersigned approves this Installation Report and 51pnj 'h l
Record Drawing on behalf of Mason County Public Lac sEo oFslcr�iER - 'H 1K
Health:
Ytrrn �� �� 2t'j
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 Wmsantrmte
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NOV 12 2024
MASON COL TIE src,,v ,TAi HEALTH
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