HomeMy WebLinkAboutSWG2023-00434 - SWG As-Built - 10/13/2025 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00434 Parcel # 32007-14-90031
Applicant Name Dan Parker Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box -___ ________---
City, State, Zip Shelton, WA, 98584
Installer Name House Brothers
Site Address
241 E Hiawatha Blvd, Shelton Designer Name Arrow Septic Designs Inc.
INSTALLATION CHECKLIST
Repair ®Other 1,25o gallon tank at Shop
Drainfield Only ❑ P
® Full System Installation ❑Tank(s)LiOnly ❑ ent Type
System Type Sand-Lined Pressure Bed
VI..\\- �- ❑ NIA Q YES ❑ NO
>5 ft.from foundation? 57, , t_- - ❑
I 't] s� ❑
>50 ft.from wells? - 0
• >50 ft. from surface water? - . Tv-� - 7.Q2 _ �h, •
z CI• Cleanout between building and tank? , - --_ ,. a 0
U Tank baffles present? - `_ �_--- ❑
a24" access risers over each compartment?- - - -`—_ =- --- - 0
W Effluent filter installed?- HB Tanks
Septic tank capacity (working)
1250 gal Manufacturer
❑ N/A ❑ YES El NO
0 D-box water level and speed levelers used? - - ❑ 0
�O Manifold/D-box accessible from surface?- El El ❑
u.
mZ Check valves installed?
c!)a 2.. Schedule/Class 40
2 Transport Line Size
Bedrooms installed (check one) ❑ 2 0 3 0 4 0 5 ❑6 ❑Commercial/Other
❑ N/A E] YES ❑ NO
>10 ft. from foundation?- 0 � 0
a >100 ft. from wells? ❑ 0 ElW >100 ft. from surface water? - 0 0 0
LL >10 ft. from potable water lines? 0 a El— > 5 ft. from property lines and easements?- Elcc > 30 ft. from downgradient curtain/foundation drains? ❑❑ NI 0
a Drainfield level and observation ports present -
0 Graveless chambers or ® Clean gravel used? (check one) 0
Proper cover installed over drainfield? 0
N/A El YES El NO
Pump tank setbacks consistent with septic tank? - ❑ Hg Tanks
1250 gal Manufacturer
Pump tank capacity (flood)�_ El .1 �
Z 24" access riser(s) and accessible from surface?- ❑
I- Alarm or Control Panel Installed? - ❑ ® 0
a, - 0 0
g Control Panel equipped with Timer/ETM/Counter
Pump installed in ❑ Bucket or 0 On Block or ❑ Other Transducer
a- Pump Make/Model
Liberty 290 0 Floats or ❑
R_ Tank draw down 2 in/min Pump capacity
a48 gpm Squirt Height 5 ft
6 hr. Daily flow set at 480 gpd
Pump on time 2.5 min Pump off timeUpdated 8/21/2018
Parcel# 3200-1 I`
Mason County OSS Installation Report pg. 2
ABANDONMENT RECORD ® NO
Were existing septic components abandoned as part of this project? - 0 YES
If yes, please describe: (� YES NO
Were all components pumped out and properly abandoned per WAC246-272A-0300?
RECORD DRAWING
tank location,North arrow,reserve dralnfield,existing and proposed buildings,location of wells.waterlie
This is a permanent record and must be accurate and decrptive enough to re-locate in the need of maintenance activities and future development Typical Record
Drawings o contain: Drts,cl d o manifold t orientation&layout,Septic/pump
wens,observation ports.cleanotts,and other maintenance access points. Incomplete Record Drawings may create additional delays,n final installation approval and relatedpermits.
V� Oi \Ck-°1\k.k
J Record Drawing Attached
CERTIFICATION OF INSTALLATION
DESIGNER! ENGINEER
INSTALLER
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 and Mason o County
Public
Health and meet all
y
odes
and Mason County Codes. Staatinn ^t3innrl O.^. this
I further certify that all information contained on this I further certify that all inform
form and attached Record Drawing is accurate.
form artd attaci�d Record Drawing is accurate. �
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Signat re of Installer Date 07''
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Printed Name of Signee � , :0 ,yJ
MASON COUNTY PUBLIC HEALTH ,ia a9 ;��
The undersigned approves this Installation Report and •
�' • PAULA JOY JOHNSON .cst•
Lit. SE. 19LSfGN�f��� '
Record Drawing on behalf of Mason County Public i wI'� c c
Health y6'` 0( 131l/ (p _23- 14
Signature of Environmental Health Specialist Date
(stamp, signature and date)
Updated 82ti20t8
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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