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HomeMy WebLinkAboutSWG2020-00200 - SWG As-Built - 9/21/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00200 Parcel# 420213200030 Applicant Name DONAL WOOD Subdivision (Name/DivBlocklLot) Applicant Address 894 CARMAN RD S N/A City, State, Zip SHELTON,WA 98584 Installer Name JAKE GOLDY Site Address 894 CARMAN RD S Designer Name ADAM HUNTER INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑Dralnfleld Only ❑ Repair ❑Other System Type PRESSURE TRENCHES Pretreatment Type N/A >5fL from foundation? --- ----- - ------------ -- ❑ WA ®YES ❑ NO >50 ft. from wells? -- - ---- --- I {� ({�{�� � ❑ ® ❑ >50 ft. from surface water) - - ---- _5--- OWA - ❑ O ❑ Z r Cleanout between building and tank? - - ❑ ❑� ❑ -aes�-r�o-zs-- V Tank baffles present? - - -- ------ 0 0 ❑ a 24'access risers over each comps - ❑ ❑� ❑ w Effluent filter installed?-- - -- --- - ❑ ❑ Septic tank capacity (working) 1200 pal Manufacturer INFILTRATOR OD-box water level and speed levelers used? --- ------------ ❑t N/A ❑ YES 0 N DOManifold/D-box accessible from surface?---------------- - ❑ I ❑ C9 z Check valves installed? --- --- - ------------ ----- - - U ❑ ❑ Transport Line Size 2" Schedule/Class 40 Bedrooms Installed (check one) ❑ 2 ©3 ❑4 ❑ 5 ❑8 ❑CommerclaVOther >10ft.from foundation?--- - ------- - - ----- ----- --- ❑ N/A ® YES 5 N >100 ft. from wells?--- - -- ----- ---------- ❑ ® El W >100 ft. from surface water?---------- -------------- ❑ ® El ME • >10ft.from potable water lines?------ ------------ ---- ❑ ® ❑ az > 5 ft. from property lines and easements?--- ------------- ❑ © ❑ >30 ft. from downgradientcurtain/foundatlon drains?- -------- - ❑ ® ❑ Drainfield level and observation ports present - --- --- ------- 0 ® ❑ ❑ Graveless chambers or $ Clean gravel used? (check one) Proper cover installed overdrainfield?------------ - ------ ❑ N ❑ Pump tank setbacks consistent with septic tank?------------- 0 WA ® YES ❑ NO Pump tank capacity(flood) 1200 pal Manufacturer INFILTRATOR Z 24 access Olten(a)and accessible from surface?------ --- ---- ❑ ❑ Alarm or Control Panel Installed? -- ----- -------------- ❑ ® ❑ Control Panel equipped with Timer/ETM I Counter--- -- ---- -- ❑ IN ❑ a Pump installed in ❑ Bucket or • On Block or ❑ Other a Pump Make/Model ZOELLER N152 ® Floats or ❑ Transducer Tank draw down 2 In/min Pump capacity 48 ppm Squirt Height 4 ft Pump on time 1.25MIN Pump off time 4 HRS Daily flow set at 380 gpd Updated W21/201B i Mason County OSS Installation Report pg. 2 Parcels 420213200030 ABANDONMENT RECORD Were existing septic components abandoned as pad of this project? --------------- - YES © NO If yes,please describe:N/A Were all components pumped out and property abandoned per WAC246-2?2A-0300? --- ----- O YES ® NO RECORD DRAWING ml.Is a pemlananl ncwd aid must b anunu and dncrlp've enough ra re.lxeu In the nee0 oe manbnanc,sNVMe.end mwn arv4lon'n.nl Typ S Rcd D(w wa cwnbu: enhryk a manacld o,%swi 6 hyal.rW&u—p—k kca4:n.how, nave dnl,Foe oX 4ltW cod pti%Med hubNga,hcsiikn d mlb,we'allnm, wel4 absenrjT p[N,CI]nala,Md oTx lnantnnce access ooe'.la •.nc 'cyre Fe'wd A' k.r snayCrmle e1Nlbne.dWyi Y.hat hsl4ielbr approval ak refit. perNlc. I Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 certify that the system has been installed in accor- Me 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 end that any deviations here have been cleans approved by both Me designer shown here have been clears d/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. 8110/26 SicrWfe of Installer Date JAKE G0LDY Printed Name of Slgnee /1.0 MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: R(z�1 SignaWs of Environmental He lth Specialist Dale (stamp,signature end date) THIS FORM MAY ae SCANNED ANDAVARABLE FOR PUfLIC YEW ON THE MASON COUNTY WEB SITE epdaladvnrzots RECORD DRAWING (continued) 3 @@ G2 Pa T ! � @ - { } ! � \ � \ | � « � flcç D ; . ! $ J ` t ~ i \ k �r I i, > 0z / O ^ ^ t ) \ x / « ! N \ ~ :D � � -/ - §�� � ± \ c $ S \ � ) ; \ ) � \ { \ [ ' ' I : @ . { ! § § § g # `