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HomeMy WebLinkAboutSWG2021-00212 - SWG As-Built - 1/6/2023 Mason County OSS Installation Report pg. 'I MASON COUNTY PUBLIC HEALTH .%CP PLI0:ANT1iPERMIYINF RMVIAtI.Qs, ' sky*,t;i,Ago T tY Affi*',. - Permit Number SWG Z COZ 1-- 00 Z 1 Z-- Parcel # tX (9 L i'/r ,/02 Applicant Name Wm Aie,shPil Subdivision (Name/Div/Block/Lot) Applicant Address cif NE /-lav<,, take_ D,, City, State, zip . t'/I- 9 gSgX Installer Name 1 /• • Site Address Q.9/ r Designer Name . , INSTALl.ATIQ ‘QMECKI IST,v* ,. 11' , ., ' -.., '. • 0/Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other System Type N 1-)\/�IN 1r1-(.1(\.._- T U NCI',SS°(1.- "Pretreatment Type tJ vw/V-CI >5 ft. from foundation? - - ❑ N/A []YES ❑ NO >50 ft,from wells? - - ❑ ff�.,/ ❑ >50 ft.from surface water? - - 0 LA" 0 1.5. Cleanout between building and tank? - - ❑ Etv�-,/ 0 U Tank baffles present? 0 L� 0 /- ;''24" access risers over each compartment?- - ❑ El'' ❑a. �.,/ W , Effluent filter installed?- ❑ ❑ LK u) 1� C- >2vvt(,FN Septic tank size 7-5 O gal Manufacturer A:'_ :. D-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO ►.Q Manifold/D-box accessible from surface? ❑ ❑ S; ,. Check valves installed? •- , w iTransport Line Size 1 -.,--.5- Schedule/Class LA Bedrooms installed (check one) 0.1 ❑3 0 4 0 5 ❑6 0 Commercial/Other >10 ft. from foundation?- - ❑ N/A [rr YEs 0 No '6 >100 ft. from wells?• - ❑ �`�U ❑ 75 / El >100 ft. from surface water? - • 0 u-) ❑ '' ,-ti, "1+ -IJJ'.;,.;>10 ft. from potable water lines?- - - 0 0 ;#. > 5 ft. from property lines and easements?- • ❑ ��/ 0 > 30 ft. from downgradient curtain/foundation drains?- - 0 l ❑ — �...- .;-;,,.1.: Dralnfleld level and observation ports present --_ __-`- - • ❑ ✓[�G�raveless chambers or 0 Clean gravel used? (check one) Proper cover Installed over drainfleld?- - 0 0 Pump tank setbacks consistent with septic tank?- - ❑ N/A [ YES ❑ No Pump tank size I' O gal Manufacturer 1-1 ct YLNt VAc3�.) Q24" access riser(s)and accessible from surface?- - 0 ©/ ❑ Alarm or Control Panel Installed? - - ❑ ©� ❑ Control Panel equipped with Timer/ ETM/Counter 0 © ❑ 4 Pump installed In El/Bucket or 0 On Block or ❑ Other .� ,e L t ► �1 T 2 L✓I Floats or ❑ Transducer 0 Pump Make/Model t y r c `Tank draw down ( in/min Pump capacity Z-- gpm Squirt Height __ ft Pump on time 5 � C, e- Pump off time �- rt Daily flow set at 'col t,) gpd U1Anlnd W21120111 1 Mason•County OSS Installation Report pg. 2 Parcel# rt, { ABANDC ..., T:REOO. D,. t r y t,Y,fet, . :,h.., .• t f Were existing septic components abandoned as part of this project? - - [] YES IND If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 NO .- . . , ... ' RECORD D_ WING ,I ,4 a_# ',,...M" :i^�y�f .. ` . . ... This Is a permanent record and must be accurate and descriptive enough to relocate In the need of maintenance activities and future development. Typical Record Drawings contain: Drainrield&manifold orientadon&layout,Sepilo/pump lank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. [Record Drawing Attached _ p L' 1' r t 'W _ '�Q' a. 3 y 1+. g "'X.`,'_.�,:Y,�jr'S �,� EtCTIWIOATR)f 4F I f$O hgtfti . ,;�.�°i`. ^:. "al _ ;: �. .... ', �i e ��:fiG 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 Slate myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further ce ify that all Information contained on t is I further certify that all Information contained on this form `n attached Re r Dr w' g i form and attached Record Drawing is accurate. ig lure of l it D to ubi(L. , /---/i/t/bh-t,;/. / ccik Printed Name of Signee 't '� F" (( r MASON COUNTY PUBLIC HEALTH ,(n,, ., 4 "''"" ,(1.�• ` qW " ''fi`. The undersigned approves this Installation Report and ,t • {}`? �;.;:1; uk; Record Drawing on behalf of Mason County Public l •rr.;i-,c,.t t'•,V3 Health: r!pip`-' IZ q IS 2 \(6 (?T 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 8121/201a i , * * * * > 0 0 Z > > ' I- X C O rr- I m -11 z -I O O m D z D my D Z o c rns CDj 0 0O -D-I !) C/) rn c.n * m z m m r-ri C/) n cn m cn cf) D 00 Om z O O • 8 -0 m m c m -1 � 7 0 /� > 7 CO D D � C n rns � 0 m > > X m --{ �7 0 _' mCZa /ZZmmI- QDrn N " nm m G c„ `� vr= Wm H nzz 'CQ = � 70 o r' Tl sO > DO -< Z 2-1 z O 0 = m D r- O `D 0 o y m cl � m , �i) z r »3�ovS 7 o m 71 o D �I �1' O D D Cn m C/� `� N/13a�H 51.7., `— r m z 0 O C /,� M z rn 1° �$ o H � � n 7 --I rn O Co 0 `/•00 vio� O M o Z7 O z .k° -I e• / C zi -cil 3 p v oo�Orn � /m rn � 3:.' P -O --r^ o "- J Rl O M 9r 73 1 m s • �%Y IIiI11ij 'I- .;''✓M ..'.OI. 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