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HomeMy WebLinkAboutSWG2021-00237 - SWG As-Built - 6/21/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG ZOZ 1-OOZ 3.7 Parcel # 3\qp f G)5 Don qq .44,0 Applicant Name 1'Y\pi'C(, ?TQYY1Q. Cp`QN-ucANl Subdivision (Name/Div/Block/Lot ✓, 4, Applicant Address pb t? ,c, a 4� k G? ,J'' City, State, Zip �Qt , \J\.A Rgl22t Installer Name TeSSG k-Vo - Ns� 7,, 4,, Site Address 20\ S , alaSoi nk-0\Q Designer Name cerA fts Fika.- L, INSTALLATION CHECKLIST • (cg Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type ' StAbSU e4 oft..f° ,0 , ,k,t -' Wretreatment Type tILL,vIO ,Y2 t3hs2.-SW >5 ft.from foundation? - -- ❑ N/A 12'YEs ❑ NO >50 ft.from wells? - ❑ [r ❑ Z >50 ft.from surface water? - -- ❑ ErEl < Cleanout between building and tank? - -- ❑ [' ❑ O Tank baffles present? - - ❑ Er ❑ a24"access risers over each compartment?- El Er,,, ❑ rW Effluent filter installed?- - El [U El o Septic tank capacity(working)t1 A\NO.p, �Jh2.� gal Manufacturer Sot.,,r.c) Ak.w C .o 0 D-box water level and speed levelers used? - - dN/A t ❑ YES ❑ NO a0 Manifold/D-box accessible from surface?- - -'aci LNd01-$ - ❑ ©' El mZ Check valves installed? - -- Er ❑ ❑ CIQ Transport Line Size , tin.Gtti Schedule/Class &CM 40 Bedrooms installed (check one) ❑ 2 a3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- -- ❑ N/A ['YES ❑ NO d >100 ft. from wells?- - [/ ❑ -> >100 ft.from surface water? - - g Er ❑ W cc >10 ft.from potable water lines?- - ❑ [d ❑ Z >5 ft. from property lines and easements?- - ❑ [jam ElDe > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ o Drainfield level and observation ports present - - [] 10 ❑ , ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield? -- ❑ Et ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A L 11 S ❑ NO Z Pump tank capacity(flood)/�U gal Manufacturer SPViV1) { „lqZ.-ewl job'" < 24" access riser(s)and accessible from surface?- - ❑ Er- ❑ dAlarm or Control Panel Installed? - -- ❑ Er ❑ Control Panel equipped with Timer/ETM /Counter- - ❑ E ❑ a- Pump installed in ❑ Bucket or ["On Block or ❑ Other & Pump Make/Model bit -I'-'CO t2F 2003- n Eltioats or ❑ Transducer • a Tank draw down / in/min Pump capacity /3 _gpm Squirt Height lUti1 ft Pump on time r'MOO- Pump off time I I-1-1Z- .14 h't I Daily flow set at ' t0 0 gpd �'� Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES0/w NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES,J l ❑ 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: Drainfieid&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,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 J 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 nd attached Record Drawing is accurate. form and attached Record Drawing is accurate. s Le areof insle 7-C-3St+ S - Eft)LT Printed Name of Signee 9; MASON COUNTY PUBLIC HEALTH • The undersigned approves this Installation Report and : sS Cssa �: TRAVI C.BI1CK LICENSED DESI NER Record Drawing on behalf of Mason County Public EaP FEs ii-v-zo Z Health: 1C... lreiriT CO1 ((7:7 I'zz Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 • U) D m -0 5 o o v m o 'v N n -0 cg w a v c -a m y ._. 3 _ m o. °• m (D (D - C cD D O Z Q- cD N `‹ CCD Z C = C co a Iv c v n O 0 3 `< m a X ° _ Iv m cD. Iy Crm O c Z.S. CD Z Q 5 —a (7 0)co cQ co �' y N = W O cD cD co N y' > 0 10 i Nx v v a j 0 60 O O CD n. g co C. � '� v - tO O y .0 S (7 Cl) o a DJ CO U1 ._r O . p C a tD 5• O N gUl O N 7 ` = N -' r. D) N V r % •`'< 5 cD - on C4 � cD N• tea. cn O cD v O 27-. QQ N = O C - o < a a' o , % Ow ' �.. --1 Z tv m N a) 401r cm a) o 7\ o a)m O dL y O < N O Iv 410 5 spv G < \ too. Q • O \ 1p cn 00 if Ocn N •NU N �• A Q� D N q a) cD \ \ Z W co D 11 Ns\ T 0 Wp j N\ > "/ N r 95.3 N X P. No m� �"� CD CD-' N II Iv Ff.. D. al N N n<i - � � V o m oD ;- Co aj m U cD �•I• m m nii cn N m T! .o APPROVED C _ � W � cn m o N D m T cn co (II o cD ;IV JUN 27 2022 3 T + :�N_ MASON COUNTY ENVIRONMENTAL HEALTH (p� n.. �, RET `g •. .. F m _ 4 s n qsr N ? m N V a • tD cco o y , O- Vtzn ,'' � C C Oi T •...j,5 O cn N S rn O