HomeMy WebLinkAboutSWG2020-00438 - SWG As-Built - 2/27/2023 1
Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION ,/
Permit Number SWG • „0 • b it �� p
C) g Parcel � / 3 o`/ /7 60,6i
f Subdivision (Name/Div/Block/Lot)
Applicant Name a.r�t1Z- ,,ll
Applicant Address rat� yV r �J�Q✓S
City, State, Zip I
v1`Q�• A(, 5,' Installer Name ULi_DP U,
Site Address 21/ -7F Designer Name
INSTALLATION CHECKLIST
:-: g
Drainfield Only 0 Repair ❑Other ,,, I�l
AFull System Installation ❑Tank(s)Only ❑ �`�System Type r. / Pretreatment Type C=:1
-. ❑N/A YES ❑:NO
0ti
>5 ft, from foundation? r� Jr!
>50 ft. from wells? t i
`-� >50 ft. from surface water? - - ElEt,
..
H Cleanout between building and tank? ❑ ❑
❑ 0
V Tank baffles present? - Sy ❑
- 24" access risers over each compartment?- - ❑ 0
a.
III Effluent filter installed?- -- - ❑ EY Septic tank capacity (working)
cn
i5tD gal Manufacturer Nose Aee
o D-box water level and speed levelers used? - NIA ❑ YES ❑ NO
J NV ❑
�O Manifold/D-box accessible from surface?• ❑❑ � 0
u.
c92 Check valves installed? ft
Q Schedule/Class Ii 0
• Transport Line Size
Bedrooms installed (check one) ❑ 2 -3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - ❑ N/A ❑ NO
ft. from wells? Cl ❑
� >100 � Cl
W >100 ft. from surface water? ❑ ❑
u. >10 ft. from potable water lines?-
- > 5 ft. from property lines and easements?- - ❑ tl' ❑
12 > 30 ft. from downgradient curtain/foundation drains? • - - • 0 ❑
13
Drai field level and observation ports present ID ❑
fitafGraveless chambers or El Clean gravel used? (check one) 0 CI
cover installed over drainfield?• -
Pump tank setbacks consistent with septic lank? - - ❑ NIA YES 0
NO
• Pump tank capacity(flood) 1200 gal Manufacturer Hoo SG
Q 24" access riser(s)and accessible from surface?- - D 96 ❑
F-a. �/
Alarm or Control Panel Installed? • • 0 0
2 Control Panel equipped with Timer/EFM/ Counter• ❑
El El
fl- Pump installed in ❑ Bucket or O Block or F] tattier
0 /O Mjl�3 ( �f (4 Floats or ❑ Transducer
p ip Make/Model_ UIm�l.� f'i Nfi ,,
Tank draw down in/min Pump capacity gpm Squirt Height �O S
a �
Pump on time
Z.PANn Pump off time 0 IACS Daily flow set at 2-1 O g d
Mason County OSS Installation Report pg. 2 Parcel# 3 1 l9P — 6.() J 0
ABANDONMENT RECORD
Were existing septic components abandoned as pail of this project? • - D YES 111 NO
If yes, please describe: __ _
Were all components pumped out and properly abandoned per WAC246-272A-0300? - YES [] NO
RECORD DRAWING
This is a permanent record and most bo accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Iypxal Record
Dravnncjs c.wnam Drainfiekf R mandoki orientation E layout.Septic/pump lank location.North arrow,reserve drainfield,exislurg:md xoposed buildings,location of welt:,waterinun..
wells.obseivation ports.cleanuuts.and other mairdenanco access poinls. Incor, ilelc Record I):n irn)s may veate addiGexsd delays in final installation approval and related puumtn.
i
C1444"6 ‘ ....tii:41..
o Hoots
8 •
ft)ON r‘. ..,‘,
® 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 inform Lion contained on this I further certify that all information contained on this
form and attached Recor drawing is accurate. form and attached Record Drawing is accurate.
.a..1*Ar. 2. CO 2. Ni `t
Signal ‘Installer ate N• , > ti
Punted Name of Signee /Y7 '^• : %�'��,
:SL:: l :z: lat!on
Report and ((�� 27
`
Record Drawing on behalf of Mason County Public �JA -
,ICN:R
Health: •._ -...
ti� z/b/Z 3 1. . 3 3 4 ,
Signature of Environment l Health Specialist Date (stamp, signature and date)
THIS FORM MAY RF SOANNFI ANfi AVAII ARI F FOR PI IRI tO VIFW ON THE MASON col INTY WFR SITF Upddica 8/21/2°18
RECORD DRAWING (continued)
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