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HomeMy WebLinkAboutSWG2024-00290 - SWG As-Built - 10/1/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00290 Parcel # 32021-53-04038 Applicant Name Tho Nguyen Subdivision (Name/Div/Block/Lot) Applicant Address 3335 43rd PI NE SHORECREST ADD REPLAT BLK:4 LOT: 38 City, State, Zip Tacoma, WA 98422 Installer Name Workman Contracting Site Address 180 E Bridger Ln, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - L - ❑ El El>50 ft. from surface water? - - ❑ II El z Q Cleanout between building and tank? P xJ N ❑ ❑ El V Tank baffles present? - - ❑ El El f- 24" access risers over each compartment -- ❑ ❑■ El a W Effluent filter installed?- ❑ N ❑ u) BY Septic tank capacity (working) 1,250 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - ❑ N/A ElYES 0No o0 Manifold/D-box accessible from surface?- - ❑ ❑■ El o0Z Check valves installed? ak 4,1/4,. - El ❑■ El aQ E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO 0 >100 ft. from wells?- - ❑ El ❑ W >100 ft. from surface water? - - El ❑■ ❑ u,. >10 ft. from potable water lines?- - El El El Z > 5 ft. from property lines and easements?- - El UI ❑ a cc > 30 ft. from downgradient curtain/foundation drains?- - El (I] ❑ ci Drainfield level and observation ports present - - El © El ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - El El ❑ Pump tank setbacks consistent with septic tank?- - El N/A ❑■ YES El No Pump tank capacity (flood) 1,060 gal Manufacturer Infiltrator Q24" access riser(s) and accessible from surface?- - ❑ ® ❑ F- a Alarm or Control Panel Installed? - - El Pi El E Control Panel equipped with Timer/ ETM /Counter- - El El El n C- Pump installed in 0 Bucket or ❑ On Block or ❑ Other a' Pump Make/Model Liberty 280 U] Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 3 ft Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd ,;cdatec 8.21 2318 Mason County OSS Installation Report pg. 2 Parcel# 202 "S —CSC03� ABANDONMENT RECORD _ 0 YES X NO Were existing septic components abandoned as part of this project? If yes, please describe: E YES [] NO Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING Record This Is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activitiesandd fubJre d ve��en welypical e Drawings contain: Drainfield&manifold orientation&layout,Sept cipump tank location,North arrow.reserve drainfield,existingproposed final installatgs,ion approval and related edi es. wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays *Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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. C'01/1-4__, 02.-- l l —2_S Signature of Installer Date . , ,pit_k.I . u, c,,R.x.2.tavact. ..e•..•.f...‘t.),) Printed Name of Signee ..' • MASON COUNTY PUBLIC HEALTH f , 4.' , The undersigned approves this Installation Report and ,,- sto 340 `l) a P.AULA JOY JOHNSON .lyVI) Reco swing on behalf of Mason County Public i • SAY}��t�ty elk, ��..,„ ,���1�s He h: Q 7. ri 5 l d�l Z(91,04ryF CS Signature of Environmental Health Specialist Dif RpN //2'' (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR-ViALIC VIEW ON THE MASON COUNTY WEB SITE updated 821/2018 ,'!J0T r _ , o 4......... : '''"''°"C ' 61b, slope.c (�, -5',/ -s-).5 ?Q:0-4.k \ i Ff�� ` �.505;. S • \:); o d a . � . 1-5 (- t j3l v c.}G M A NA),•Pc./ �S2s�2zS`— O©o(cOD Ott i� 1 ti:1 i 1 LiiiiiiuiL .111 Cie�o�it W�` � (�� t,�-SAC- 1 o z Sep c Tank `Z.1DC�= t ti �./ 2-Co-apr.;�:,;et:t with E`.went ?ter n 4 Ga.Uoa Prima Cfsa.:_be- ...1k A PPRovEri �J kb. o�v.-r=-S�P how CV2 ve Comoi Box' is fi .° 1.L.:A OCT 0 12025 tea' I `Q . . g ,,,.. 1 MASON COUNTY ENVIRONM .-. • ENTALN,EA,r; 510'3494. D I^ �- � r PAUTA JOY JOHNSON JH •L ;;a�s nE iGN 41- Z.f-Zs-