HomeMy WebLinkAboutSWG2022-00634 - SWG As-Built - 4/28/2023 '411-
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''hayon CountyI i !OSS staltation Report p . MASON COUNTY PUBLIC HEALi h
APPLICANT/ PERMIT INFORMATION
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Permit Number SV• G ZtL2 d) ('S/ Parcel# /7.-zo 7-fi.ka --ea)p 2.
Applicant Name
r✓� :. Subdivision ;Name/DivBlock/Lot/
Applicant Address _±^.
City. State, Zip ' /NM qggriii installer Name 'T1L411 3, At
Site Address izZ £ /c kc vl�:(CAA t 4.6esigtter Name Cihoy IJ-.if•`
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INSTALLATION CHECKLIST
Full System tnsioll4tin; ❑ Tanks)Only� 0 ..,:r -k:�,�-
:i� ❑Repair 0 Other
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System Type `� .11fdpAlastAyi_ati 4,55gtflifetreaLren:Type_ �/9 t
>5 ft.from foundation? - - Gili (� ((� (� - -(-- •( nN;A YES ❑ No
1 >50 ft. from wells? . -• tE Cu - LE- 8 -[ ,s
2 -5t)ft. from sort-.ce dater? . - - - - - _ _ _ _ - -
_. Cteanouf between btiplainc, ana : nk? - -APR.212023 J
• fah: batesprnsentt -- - - - - - - _ _ _ _ _ _ _ _ . L"1
El 1-1
24' ac-,ess risers cv r each compartmen:"- •- - - By - • - - - - - i
+:•fftuent'ilter installe 9. -. -- - _ X 0
Septic tank capacity f working)_/v - ;la; ;; ,i,-ifact'.,rer - f -Y6�e,Lkc n1
• 9 D-box water level any speed levelers used? - - - - - - - - - - g NIA ❑ YES ❑ NO I
GCS Manifolc;D-cox accessible from su,face?• - - _ _ ❑ RI 0
mk- Check valves installeki? - - - . .. - - - - - - L.-, ,.�--'t, 0
02 Tr ,sport_lr.e b ze _Gu ,/ Sell::-':i!eil.ias: __1 _ _____ I
Bedrooms installed (peck one) ❑ 2 Z 3 ❑4 Ej ;: 0 6 0 Corn nercial:Ctner
>13 ft. from tounc?atlokt?- - - ❑ NIA ,YES ❑ NO f
fl >100 ft.from wells?- _ . _ _ _. .- _ . .. _ _ _ _ _ _ _. ❑ r-e
W >100 ft.from surface'Water? - - _ .. .. - - _-- ❑ IT 0
ti >10 ft. fror~potable Water lines?- - •- -• - - ❑ 511
Q >5 ft.from property lilies and easements?- - - - - - - - -- - - - _ _ _ - 051 0
30 it.. frog" 'jr,vI•;i.n.a 7!ent curia;nifeurida:ion drains? - - - r'1 a 0
CI t1r L_J
ai:�fietd level 1.in;i o servation ports present • - - - _ _ _ ❑ 0
0 G; veiess chair.* rs or 4, h!C •t. ,'.;rFiVE i ut'::ri i . i;t-' ':!- a ne)
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Proper cover ir-,stalle;,o,ier tlraiilfietc:?- - - -- - - - --- - _ .- - -• -- -- . . i2i 5K1 0
Pump tank setbacks ±:i istent with septic tEi:ik:? - - - I—�
1 0 NiA YEs 0 NO
tedQ Pump tank capacity(fkod) j2.1''i gal Manufacturer-_-- :ntu,.,1-_Ali
24'access;iser;s)aril accessiUle from surface? - ❑ ❑
s._
t� Alarm or Control Pane Installed? . - - - _. .. _- - - - - - - -- -- - - - - - - 0 0
Control?anal equipped with Timer i TM Counter - - - - -- - - - _ - '4~�',54
0
t
i? - Pur-,p installed in ❑SBtcket or 20 On Block or ❑ 011ie.-
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a. Pump MakeiModal �� loafs or
:: 0 Transdu r
I p Tank draw down _ rii
�. _____nri nin Pump capacity.-._r ._ - -gem Squirt Height yi 4 ft
iPump on time d 'f ui*I( Pump off time— L Dail flow set at t MIL__ y Z'fpgpd
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1 Mason County OSS Installation Report pg. 2 Parcel tI
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ABANDONMENT CORD
/:,41-e existing septic components abanconec ab pan (L•. It.;),E.etI
r YES EjNO
CC. pleas(' describe - 1/rJ- LJl Y ft✓l
i *ere all compone1ls pt:thpd oil and properly abandoned per WAC 6-272A-0300? - - AYES
0 NO
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RECORD DRAWING
.:u,as a permanent record and mutt he accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Tyfrcai Record
•Pas.r,g„..,ar::en Ord ntatiJ a na..na!ol1 vna,t::t.n&layout.SnGuctptdr,:;o.: vaC.:r. \.,iT auo.:.•es•-,r ie a&rabtflo a rxtStuay:aid cIQpuced b th :..ax::num of well. ohser at,un ridrrs,c:,a^outs,aodir:hea rnarme,�ance access Co!^.r. int ^^n . -,t.1^ welts relatedwa permits.
rrva^,_.-r,, rr gr .e::i kn,a:d:as,t. r 4n.1 ma F1liatbn as^SJY91 and pertidts.
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FIPPROVE
ilitt �t DGl,,ev APR 2 l 2023
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
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gRecord Drawing Attached
CERTIFICATION OF INSTALLATION
1NSTALLER I
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. stamper '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
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form.and attached Record Drawing is a curate. form and attached Record D�,wing is acr;urate.
oil
C1,1,...X.) 1 2-41 110 2.3 0. i
Signature of Installer Cale i�� ••�t1
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Printed Name of Suiuee
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• MASON COUNTY PUB HEALTH HEALTH o y E ai,
The undersigned a ppiove 1 �� DY E. AIT f'�' )1
ig . this Installation Report and „ LICENSE,D DESIGNER o
ia
Record Drawing on behalf'tf Mason County Public +t.���..��>.���V� o�+o�taf,
,t,a EXPIRES 05r10r
,./.. (1),(6%-di__ir,
its
1 Si nacre of Environmental ti clth SG:::.;ust ur,r,.
(stamp, signature and dale)
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THIS POR(J.kr.A SE SCAVNEG AND r:v:•.a..'.r Le-;=DR Pub;iC VIEW ON THE r;'ASON COUNT'? .'VEB SITE updated 8at2018
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RECORD P R ti.ANG Continued
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