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HomeMy WebLinkAboutSWG2024-00065 - SWG As-Built - 8/4/2025 .0, CLEAR FORM Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00065 Parcel# 22009-50-00026 Applicant Name MICHELLE VOTE Subdivision (Name/Div/Block/Lot) Applicant Address 8514 18TH AVE NW City, State, Zip SEATTLE,WA 98117 Installer Name GENE BOND Site Address S E PICKERING LN SHELTON,WA Designer Name CINDY WAITE INSTALLATION CHECKLIST 0 Full System Installation a Tank(s)Only ❑Drainfield Only 0 Repair ❑Other System Type Zund Pretreatment Type >5 ft.from foundation? - 0 N/A II YES 0 NO >50 ft.from wells? - -FLs R-?i�}�j-�.- ❑ IN NC Z >50 ft.from surface water? ----- —� Lll lJ El 0 FQ- Cleanout between building and tank? -j bt- i- 5-- ❑ a ❑ ✓ Tank baffles present? - ❑ ® 0 d 24"access risers over each compartment?---- - CI CI iu Effluent fitter installed?- By ---- ❑ ■ ❑ cn Septic tank capacity(working) 1050 gal Manufacturer SOUND PLACEMENT O D-box water level and speed levelers used? - - Ill N/A 0 YES [] NO X2 Manifold/D-box accessible from surface?- - a 0 0 2 Check valves installed? - - a ❑ 0 it 2 Transport Line Size Schedule/Class Bedrooms installed(check one) "2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - III N/A ❑YES 0 NO G >100 ft.from wells?- - • ❑ ❑ W >100 ft.from surface water? - - • ❑ 0 li >10 ft.from potable water lines?- - • ❑ ❑ Z > 5 ft.from property lines and easements?- - a 0 ❑ d >30 ft.from downgradient curtain/foundation drains?- - a 0 0 Drainfield level and observation ports present - - a ❑ ❑ 0 Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - a 0 0 Pump tank setbacks consistent with septic tank?- - 0 N/A YES 0 NO Z Pump tank capacity(flood) 1250 gal Manufacturer SOUND PLACEMENT < 24"access riser(s)and accessible from surface?- - 0 a ❑ a Alarm or Control Panel Installed? - - 0 II ❑ 2 Control Panel equipped with Timer/ETM/Counter- ❑ IL 0 m is. Pump installed in 0 Bucket or III On Block or 0 Other 2 Pump Make/Model ZOELLER N-153 •Floats or 0 Transducer LT Tank draw down �.411 in/min Pump capacity qpm Squirt Height tit" .R► Pump on time 14.gat: Pump off time -4 't\t; Daily flow set at 5 gpd upmc dea1no18 t1A Mason County OSS Installation Report pg. 2 Parcel# 22009-50-00026 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - © YES 0 NO If yes, please describe: TANKS CONNECTED TO EXISTING DRAINFIELD Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ® YES 0 NO RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development Typical Record Drawings contain. Drarnfield 8 manifold orientation 8 yout,Sepnc/pump tank location North arrow,reserve drenfield,existing and proposed buildings.location of wells,waterlines. Wells,observaton ports,cleanouts,and other maintenance access points Incomplete Record Drawings may create additional delays in final installation approval and related permits. 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 /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. 1 .1 Signature of Installer Date o 1 I DIM 15-3Na A°44 "P 9� , Printed Name of Signee • " .:_.;ir MASON COUNTY PUBLIC HEALTH ' Ati,a ?/ 4 The undersigned approves this Installation Report and D w Record Drawing on behalf of Mason County Public :" lk L=�� � R . Health: LxpurLs ts,o .3'1vk Rij-1\QA1V\FVV) qi7C Signature of Environmental Health Specialist Date 9 (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated8r21/2018 ' 11 (hill 1 I 1 I I I I IN i ? �� L 01 I ----7 --- I I i I I I I I I 9 �S'� Lie Q,�� ._- ��P . .,,� I j I I Ifiadr� '"t� 7' I I I I I lI / I 1 - V 114 JIJWWI v L�, ,'I _ ��1 -��_ L, AUG 0 4 2025 !ii i • I-r MASON COUNTY ENVIRONMENTAL HEALTH 1911 1 r-1 q ,-.2, • I L 1 \ !! pit . I . ;� . .ii. 1,1 iii 1 + k n \ T� n ot- NIL �I #; I • 11 I /� L oaatr i ":11 I 0 �a.'�; . 'w It t4- o f / �""1' y ��,; I it i 1a I I i6 f 1 —i I I I TQw� r�04 s. pH 1 I -- ; - �t-- :•` ,0, 8�1a I '` .w e QIND E AITg i I • �i ��,� l Cihs. • SIGNER ��� 7. _ _ . • . 0 1 1 ,i :: . _...._ ,o , s , w c e 2 ' C7 ' ----------------------------------------- ------, 1 ' a I . larch ' '.'„..,, r • r. I 1 r r • I , `'C MG C I ' y '... 0 R ec �S'� / ��. • • ii j I . 1 , '. 62) 4c/ -�;�-� five Jr r~1 I 4• I J cr CAI i iii r , SYlf�� r , , w • • • : •L\ I r • 4• •• '.�• (�V J1 I mrj • I i ,. 510�rA 18 -i-r CINOY E WAITE bite ' d' • i '_ LICENSED DESIGNER 4 1 N I IV I O I EXPIRES o5 t2 • ' O E , I r O I 1 i ` 3v1 l 6e? ' l 40 , ; al ` o r ea O N w I r r I r r • Z,' t Z r r • 1 I