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HomeMy WebLinkAboutswg2024-00282 - SWG Application / As-Built - 4/8/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SW a� G LU `u t- L Parcel# nold -ta - 0000'> Applicant Name Rtarnn rkr N� C I�' ' '} Subdivision (Name/Div/Block/Lot) Applicant Address City, State, Zip " �( Installer Name Vt% Site Address C {'I Designer Name WtLh RJuvr& INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pretreatment Type >5 ft. .fromwwells? foundation? --------- B > ❑❑NIA YES NO >50 R.from wells7 ------------ -Il Z >50 ft.from surface wateft ------ - ---- - ❑ ❑ F Cleanout between building and tank? - - APRQ 4IML- ❑ ❑ U Tank baffles present? - -- - -- --- - - --- ❑ 1 ❑ a24"access risers over each compartmen'8y----- - ❑ ❑ rW Effluent filter installed?- - ------------ --------- - - - - [� ❑ Septic tank capacity(working) I300 gal Manufacturer Prevki c r P Ic% LL in D-box water level and speed levelers used? -------- - - ---- - ❑ WA [YES El No �O Manifold/D-box accessible from surface?--- -- ----------- - ❑ �$ ❑ ra Check valves Installed? - --- ----- - - - - - ----- -- -- 1 '1 � ,� ❑ ° Transport Line Size I/f, Schedule/Class ASM 363cy Bedrooms installed(check one) ❑2 ❑3 V4 ❑ 5 ❑S ❑Commercial/Other >10 ft.from foundation?-- -- -- ----- - ----- -- --- ---- ❑ WA YES ❑ No ° >100 R.from wells?- ------------- -------- ------- ❑ ❑ W >100 ft.from surface water? ---------------- ------- - ❑ El IL >1O ft.from potable water lines?--------------------- - ❑ ❑ aZ >5ft.from property lines and easements?- -- ------------- ❑ ❑ K >30 ft.from downgradient curtain/foundation drains?--------- - ❑ ❑ ° Drainfield level and observation ports present - --- -- El ❑ 61 ❑Graveless chambers or Clean gravel used? (check one) Proper cover installed over drainfleld?--- ----- - - -- -- ----- ❑ ❑ Pump tank setbacks consistent with septic tank?--- --------- - tralraA ❑ YES ❑ No Y Pump tank capacity(flood) at Manufacturer Q24"access riser(s)and accessible from surface?----------- -- ❑ ❑ aAlarm or Control Panel Installed? ----- - - --------- ---- - ❑ ❑ ❑ g Control Panel equipped with Timer/ETM/Counter- - - -- -- --- - ❑ ❑ ❑ 0- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump Make/Model ❑ Floats or ❑Transducer f :) Tank draw down in/min Pump capacity gpm Squirt Height R IL Pump on time Pump off time Daily flow set at gpd Mason County OSS Installation Repoli pg. 2 Parcel# 2202-Lt - S© - OCCC3 ABANDONMENTRECORD Were existing septic components abandoned as part of this protect? --_--- - -_----_- ❑ YES NO If yes, please describe: Were all components pumped out and property abandoned per WAC245-272A-03007 --- - ---- ❑ YES NO RECORD DRAWING This is a ano.rent racmd and must ba acconda and descrlptWe enough to rvloctla In tM anad dr maMenmca eciNNla and Nturs dsualcpne nt. Typlral Record enMrga mnlaln oralMldd B maMOM mbnlatlon&dxdil Sadd ishap hes deaWn,NOM emmv,ratsve naM W,said,edd pmpcwd CUll IM ,bcalbn Nv.'ellc.wmeflnes. wells. b-.at.pods,daanwn.aM adermelnlular[a eaeea pdMa. InmmplNe Remk oraNga nuy oasts eddn'orel dtleya m @ml NWlmlun apW^"al mdrtlaud IremrAa. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER7dovistions DESIGNER/ENGINEER 1 certify that 1 installed the sysance with 1 certify that the system has been installed in accor- the septic design stamped'Ay Mason dance with the septic design stamped"APPROVED"by County Public Hearth and thas shown Mason County Public Health and that any deviations here have been cleared/apprthe designer shown here have been cleared/approved by both and Mason County Public Het 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 fo not a�ac hed� Row, 's accurate. form and attached Record Drawing is accurate. Signal tra of Installer Date -M ,7, E of SignoreUNTY PUBLIC HEALTH ned approves this Installation Report and 100Mqing on behalf of Mason County Public�,I� l( J E>sII�Ee:arwnWronmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uodamdmxvmre g n _ 3n/bQ,l�15NH7 u � oss� m �n tgj ms43o� a RO T{' r I w \ gg I 6 uGarden. � � a � N \ o / Q I1 i R I I �DmNAa"sA m � �O DAD ?rom a'i �9ti m CnnS.ry � o smog' y aX e om V I >s 3 i O T O V 7 C n T �J T _ _ _ _ _ J N�y Q CA o '/1,Q-cE m n 0 H_ M.Halverson Design LLC AARON OwnwrAnnl & NICHOLE WILSTON 58eInf, Parcel# 22024-50-00003 sH� aEa PO Box 1519 Shelton Wa 98584 60 EAST LANSKY DR SHELTON WA 98584 60 AST ANSKY OR Halversondesi nllc outlook.com nevuioas