HomeMy WebLinkAboutSWG2020-00254 - SWG As-Built - 4/1/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00254 Parcel # 320035001005
Applicant Name Francine Stevens Subdivision (Name/Div/Block/Lot)
Applicant Address 1700 N 13TH LOOP RD 120
City, State, Zip SHELTON,WA 98584 Installer Name Franklin Clark
61 E BAYSHORE DR
Site Address H TON WA a.aa Designer Name Franklin Clark
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Sandlined Drainfield Pretreatment Type
>5 ft. from foundation? - -- ---------------- -- - -- - - -- ❑N/A ■YES NO
>50ft. from wells? . - - - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ I ❑
Z >50ft. from surface water? - - -- - -- ---- - - - ElN ❑
HCleanout between building and tank? ------- ❑ ❑
U Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ ❑
I 24"access risers over each compartment?- - -- - - - - -- - - - - -- ❑ El
hEffluent fitter installed?- - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ El
Septic tank size 1500 gat Manufacturer Hagerman's Precast
O D-box water level and speed levelers used? - - - - - - - - - - - - - -- 0 NIA ❑ YES ❑ No
0J
0 Manifold/0-box accessible from surface?- - - - - -- - - - - - - - - -- ❑ 0 ❑
rot Check valves installetl? - - - - - - - - - - - - - - - - -- - -- - - - -- ❑ ❑
l2 Transport Line Size 2-In Schedule/Class 40
Bedrooms installed (check one) ❑ 2 03 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - -- ❑ NIA ■ YES NO
>100 ft. from wells?- - - - - - - - -- ------------- - - - - - -- ❑ ❑
W >100 ft. from surface water? - - - - - - - - - - - - - - - - - - -- -- -- ❑ ❑
LL >10ft. from potable water lines?- - - - - - - - - - - - - - - - - - - - -- ❑ ❑
QZ > 5 ft. from property lines and easements?- - -- - - ❑ ❑
S > 30 ft.from downgradient curtaintfoundation drains?- - - -- - - - - - ❑ E ❑
Drainfield level and observation ports present - - - - - ❑ N ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfeld?--------- ---- -- - - - -- ❑ ❑
Pump tank setbacks consistent with septictank?- - - - - - - - - - -- - ❑ N/A YES ❑ NO
Y. Pump lank size 1500 oat Manufacturer Hagerman's Precast
24"access risers) and accessible from surface?- -- -- - - - - - - - - ❑ ❑
y Alarm or Control Panel installetl? - - - - - - - - - - - - - - - - - - - -- N ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ ❑
a Pump installed in N Bucket or ❑ On Block or ❑ Other
a Pump Make/Model I iberty 290 0 Floats or ❑ Transducer
2
a Tank draw down 2-In in/min Pump rapacity 60 print Squirt Height 5 ft
Pump on time 00/00/30 Pump off time 02/00/00 Daily flow set at 360 gfp
Mason County OSS Installation Report pg. 2 Parcel# 320035001005
ABANDONMENT RECORD
Were any existing septic components abandoned as part of this project? - - ---- --- - - - - - - ❑ YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? -- ' NIA ' ❑ YES ❑ No
RECORD DRAWING
This Is a ItmemM rewN and must G eceurete and defiedd a andmi to fislecet In Me need of maltenante acavll and fast development. Typical Record
Drai mntaln. DreInGHd a manlfolE onent0on a laynul 5epfidaump lank location,NWh armw,reserve dmnraki existing and pcyactl sitarist.IecaWn IX wHls,watedincs,
well§o[aervation ptt6.cleanoue,aM other maiMenanw accebs point. Ir Aniplele Ral Drawn,may mate addanal delays In final installation app l and relakd IenniR
0 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 cleated/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
1 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.
� - • C .01AID612025
Signatureoflnstaller tJ Date
Franklin J Clark
Printed Name of Signals
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health, 01 April 2025
Signature of EnNmnmentel Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upd.Iaatli
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