HomeMy WebLinkAboutSWG2023-00275 - SWG As-Built - 9/12/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HE LTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 707. 3 — QQZ 5 Parcel # 77_635-75 - OO2 z o
Applicant Name 5.4-Gf/c, e,po,hteJG (( Subdivision (Name/Div/Block/Lot)
Applicant Address l/Z/ .c i //< Arl /I
City, State, Zip $1 j Aid s L4 476%1�/ Installer Name Th'4.O (<?ar I
Site Address //e/ Se "47//`j75 ad Designer Name ()Hay atrTc
INSTALLATION CHECKLIST
Full System Installation ❑ Tank(s)�/jOnly El Grainfield Only ❑ Repair ❑ Other
System Type 5�..((o Trc5Su 2 C. Pretreatment Type
>5 ft. from foundation? - - ❑ N/A , ('YES ❑ NO
>50 ft. from wells? - - -- -- - ❑ iSil ❑
Z >50 ft. from surface water? - ❑ 4 ❑
HCleanout between building and tank? - - -- -- - • ❑ El ❑
V Tank baffles present? - -- - - - - - - - ❑ tzl ❑
a24"access risers over each compartment?- -- - ❑ IX ❑! '
`W Effluent filter installed?- - El Igi 0
Septic tank capacity(working) I Z b( ___-_gal Manufacturer ,'/1 f -.//1.+1 p#04 Sf
D-box water level and speed levelers used? - -- - 111 N/A ❑ YES ❑ NO
' DO Manifold/D-box accessible from surface?- - ❑ ❑
m— Check valves installed? ❑ ® ❑
2 Transport Line Size 1�� Schedule/Class_ LW
Bedrooms installed (check one) ❑ 2 ril 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A K YES ❑ NO
CI >100 ft. from wells?- - ❑ [i ❑
W >100 ft. from surface water? - - ❑ El
LL >10 ft.from potable water lines?- - ❑ LS ❑
Z > 5 ft. from property lines and easements'
> 30 ft.from downgradient curtain/foundation drains? ❑ El ElGI Drainfield level and observation ports present • - Elr81 l ❑
❑ Graveless chambers or NI Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - •- - ❑ El 0 1
Pump tank setbacks consistent withh�septic tank? - - ❑ N/A X1 YES ❑ IN�
Y Pump tank capacity (flood) /45 gal Manufacturer Het ei( nc.„1 iaP .C'.S/
Z
< 24" access riser(s)and accessible from surface?- -. - ❑ E. ❑
dAlarm or Control Panel Installed? - ❑
2 Control Panel equipped with Timer/ ETM/Counter- _ - -- - ❑ M ❑ l
a Pump installed in ❑ Bucket or (Aj On Block or ❑ Other_ __ _ \ c
O. Pump Make/Model_ ,piJ(t/L- ❑
/l/,- ISZ=-.___.___� Floats or Transducer /
d Tank draw down 2 << _in/min Pump capacity. lib gpm Squirt Height 7 /� 6• ft
Pump on time 4 3^ 4-7/.4i- Pump off time _ Q4o1.v"S Daily flow set at -Z--4.0 gpd
Updated f1 11 1101 N
1.f f7rw0 4(6C-/77 x y 74.7-7(I avi 27q (t
Mason County OSS Installation Report pg. 2 Parcel# 32 O 35 - $- 6b7z1.O
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - D YES iyik, 0 I NO
ti
If yes, please describe: ---------------___-- —
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - LI YES /Vkok 0 N4
RECORD DRAWING t 1
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. Drainlield 8 manifold orientation&layout.Septicipump lank location.North arrow.reserve draintield.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.
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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 I/1
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 I
f i
d attached Record Drawingtis accurate.(or-e:).
form and attached Record /i;wing is accurate.
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Printed Name of Signee �� . Zj ,t }10
MASON COUNTY PUBLIC HEALTH !yam 5100418 �,4 l
po Ci DV E. AIT /'�',`� i
The undersigned approves this Installation Report and 7 LtCEN ESI RCl BOA
Recor wing on behalf of Mason County Public ...elm Immo. �. '_`SO ' U��.g1 )
EXPIRES 0510/
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Signatur o E it mental Health Specialist Date (stamp, signature and date)
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121,2b15
RECORD DRAWING (continued)
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