Loading...
HomeMy WebLinkAboutSWG2026-00034 - SWG As-Built - 4/1/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT!PERMIT INFORMATION Permit Number SWG 2026-00034 Parcel# 420015000016 Applicant Name Zacarias/Domingo Subdivision (Name/Div/Block/Lot) Applicant Address 201 E.NorthLake Dr. City, State, Zip Shelton WA 98584 Installer Name Wes Graves Site Address Same Designer Name N/A INSTALLATION CHECKLIST ❑ Full System Installation ❑■ Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type v' Pretreatment Type >5 ft. from foundation? ------ -- a - ❑ NIA ❑■ YES ❑ NO >50ft.fromwells? ---------- ----- - ❑ 0 ❑ >50 ft.from surface water? ----- - -- ❑ 0 ❑ z 2 T 2f26 Cleanout between building and tank ----------- - -- ❑ ❑� ❑ TankbafFlespresent? ----------y- -- ---- -- ❑ ❑■ ❑ O—~. 24"access risers over each compa -- --- -- ❑ ■❑ ❑ W Effluent filter installed?--------------------------- ❑ 0 ❑ Cl) Septic tank capacity(working) 1060 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? --------------- ❑ NIA 45 YES ❑ NO 00 Manifold/D-box accessible from surface?------ ----------- -- ❑ ❑ mZ Check valves installed? ------ --------- ----------- ❑ ❑ 0< M Transport Line Size Schedule/Class Bedrooms installed (check one) Y� 2' ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?----------------- --------- ❑ NIA ❑YES ❑ NO >100ft.fromwells?----------------------------- ❑ ❑ ❑ W --------- ----------- --- ❑ ❑ ❑ i >10ft.frompotablewaterlines?-------- -------------- ❑ ❑ ❑ z >5ft.from property lines and easements?---------------- ❑ ❑ ❑ >30 ft.from downgradient curtain/foundation drains?---------- ❑ ❑ ❑ Drainfield leveltand observation ports present -------------- ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------------ ----- ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?------------- ❑ N/A ❑ YES ❑ NO Pump tank c pacify(flood) gal Manufacturer. y=am i Z 24"access and accessible from surface?----------_-- ❑ ❑ ❑ Alarm or Control Panel Installed. - ❑ ❑ ❑ Control Panel equipped with Timer/ETM/ ter----------- ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block 0 Other Pump Make/Model ansducer per„ Tank draw down Ari1iiump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 420015000016 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- ❑■ YES ❑ NO If yes, please describe:Pumped and removed old tank Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- 0 YES ❑ 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: Drainfield&manifold orientation&layout.Septic/pump tank location.North arrow,reserve dralnfleld,existing and proposed buildings,location of wells,waterlines, wells,observation 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 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. f%/22 L '2.rrw.2 03/09/2026 Signature Installer Date Wes Graves Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Rep`ortan Record Drawing on behalf of M,so n County Public IrO Health. 0P qA o Signature ofEnvironme7(t' & ' alSpecialist 41 (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE4012 PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8212018 �ry RECORD DRAWING (continued) Nor Lath ip ,y R111RO Ty