HomeMy WebLinkAboutSWG2024-00363 - SWG As-Built - 12/19/2025 Mason County OSS installation Report pg' 1
MASON COUNTY PUBLIC HEALTH
APPUCANT/PERMIT INFORMATION
Permit Number SWG 2024-00363
Parcel# 42001-50-00017
Applicant Name PAMELA CUMMINGS
Subdivision (Name/Div/Block/Lot)
Applicant Address 3931 W SHELTON MATLOCK RD
City, State, Zip SHELTON,WA 98584 Installer Name SCHOENING EXCAVATION
Site Address 221 E N 0Y{-1 ni gk,; Dk.
Designer Name CINDY WAITS
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only 0
Drainfield Only ❑Repair []pt}. ,.
System Type PRESSURE ST Pretreatment Type SAND AUGMENTED
>5 ft.from foundation? - $_02y_ofty.
>50 ft.from wells? - -- ®YES ❑ No
Y >50 ft.from surface water? - ..M IN Cl
between building and tank? - ! YIDNJA
Uc �a ill ❑
❑ ® ❑
V Tank baffles present? - ,
a 24"access risers over each compartme _ ❑ ® El
filter installed?- 0 MI El
CO
Septic tank capacity(working)4 11 bl ❑ ® ❑
oal Manufacturer A '°` t. s r
9 D-box water level and speed levelers used? -
!RO Manifold/D-box accessible from surface? ® wA ❑YES ❑ NO
Z Check valves installed? - is El 0
g Transport Line Size 2° ❑ ill 0
Schedule/Class SCHEDULE 40
Bedrooms installed (check one) ®2 0 3 ❑4 0 5 ❑6 0 Commercial/Other
>10 ft.from foundation?- -
G >100 ft.from wells?- ❑ NIA ®YES 0 No
-
W >100 ft.from surface water?- ❑ ® 0
Z >10 ft.from potable water lines?- - 0 ® 0
0 IN CI
>5 ft.from property lines and easements?- _
GNB
>30 ft.from downgradient curtain/foundation drains?- El ❑
Dralnfield level and observation ports present - - 0 0 ❑
ElGraveless chambers or C] Clean gravel used? (check one) ❑ ® 0
Proper cover installed over drainfield?- - 0
ES CI
Pump tank setbacks consistent with septic tank? ❑ N/A ® YES 0 NO
Z Pump tank capacity(flood l gal Manufacturer `rtv�tV% 9(t-(,as-4-
24 access riser(s)and accessible from surface?- _ 0
p. Alarm or Control Panel Installed? - El
a Control Panel equipped with Timer/ETM/Counter- - 0 ® ❑
d Pump installed in ❑ Bucket or 0
® El® On Block or ❑ Other \/
a Pump Make/Mode) 1_b&w dry 20
0 Floats or ® Transducer
a Tank draw down 2 in/min Pump capacity (piao qpm Squirt Height 4 ft
Pump on time )'•Imn 5f-c- Pump off time r,'= (o y Daily flow set at
4. r� plod
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 42001-50-00017
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - r.�
If yes, please describe: - ❑ NO
Were all components pumped out and properly abandoned per WAC248-272A 0300? - - EZ Yes 0
NO
RECORD DRAWING
This Is a permanent record and must be accurate and descriptive enough to relocate In the need of maintenance activities and future development, Typical Record
Dominos contain: Drain lead&manifold orientation&layout.Septic/pump tank location.North arrow,reserve drtlnteld.existing and proposed buildings,location of wells,waterlines,
webs,observation ports,cteanauts,and other maintenance access points. Incomplete Record
Dressings may create additional ddaye In Mal Inatege/on approval and related permits.
_Ylu.3 J a i jr j et,4, Pfk— cs`/9iu
Record Drawing Attached
CERTIFICATION OF F 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
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 Drawl is accurate.
Signature of Installer Date
1%Y `3cenot�i�q s� ^, �
Printed Mime of Sigma U �� o L
MASON COUNTY PUBLIC HEALTH �` bb 8 4 '`Nl
CMD�E AITE' �.
The undersigned approves this Installation Report and LICENSEID DESIGNER
Record Drawing on behalf of Mason County Public Z
Health: �.:.. �5,,,. /)" �
t� titi\'�1� 1�( 1 �ZS
Signature oaf environmen al Health Specialist Date (stamp,signature and date)
`
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8 12 112 01 8
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