HomeMy WebLinkAboutSWG2022-00569 - SWG As-Built - 1/6/2023 4
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Jlason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG Z0Z2, —4005.0 Parcel# 31-lpti�43-owls
Applicant Name f1&,VVARo nPf, Subdivision (Name/Div/Block/Lot)
Applicant Address 25Q C 5pqm1*-.. �G 1
6 1
City. State. Zip SNcL-pis tJR /An Installer Name 3A m Pint D 1. p--rxc.,
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Site Address 341 5E Rc'5.1F, Ale Designer Name Gist)L>y-- '
INSTALLATION CHECKLIST
XFull System Installation ❑Tank(s)Only 0 Drainfield Only ❑Repair ❑Other
System Type 514AliztJ Pkii‘Ltief, Pretreatment Type- /1//A 1
>5 ft. from foundation? - 0 N/A CKYES 0 NO
>50 ft.from wells? ❑ 0
Z >50 ft.from surface water? • - - - -- -. - -- 0 igi 0
Q' Cleanout between building and tank? - ❑
rank baffles present? • - ^ 0
iF- 24"access risers over each compartment? 0 ® El
a
• tU Effluent filter installed?- - - - .- 0 ER ❑
Septic tank capacity (working) 0,00/ �agal Manufacturer 51)(411,0 4(4GeAftetri
3 D-box water level and speed levelers used? - ( NIA ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- -. - - ❑ ❑
c9QCheck valves installed? - - - - 0 1. 0
2 Transport Line Size ��_ 40
p _ Z Schedule/Class
Bedrooms installed (check ore) 0 2 ❑3 VI 4 0 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ NIA ❑ YES ❑ NO
>100 ft.from welts? 0 0
,y--tj >100 ft.from surface water? r., 0
Z >10 ft.from potable water tines?- .- (�? Vii> 5 ft.from property lines and easements'? - .i ❑
> 30 ft.from downgradient curtain/foundation drains? - - - - - O41
2 9 2022 ,-!
Drarnfie:d level and observation ports present - - - - Ei arl 0
5t Graveies:,chambers or El Clean gravel used? (check on \ r41
proper cove,installed over drairfield?• :y i pt El
Pump sank setbacks consistent with septic tank? . 0 N/A YES 0 NO
Z Pump tank capacity(flood) /500 gal Manufacturer „clump , e 1,
Q 24'access riser(s)and accessible from surface?- - - - -- . ❑ ® 0
2 Alarm or Control Panel Installed? - -- - ❑ ® 0
3 Control Panel equipped with Timer r ETM r Counter• - ❑ t;tr ❑
d. Pump installed in ❑ Bucket or Fr On Block or ❑ Gtl-her �t
g Pump Make/Model-, i[� 1J t 52. orTransducer
Floats 0
d Tank draw down Z. in/min Pump capacity 55 gpm Squirt Haight sy " ft
Pump on time /,Qg Pump off time If Daily flow set at 3626__ god
-1rlason County OSS Instailatiort Report pg. 2 Parcel 4 3,( • __; 13'5'
�_`— _ ABANDONMENT RECORD r-
f ..r,:. rf S%t,.' ^ ! "C::,_7 • n XYE^ E NO
... aescr:: .. 0.14jYi+�RL -rA70, P"`:-��,Q J . t Q W4.+ YF./0.0 +41,4e- .._
. t•Ponerrls Furnpee r,l . . .:... .tuned per'NAC246-272A-03007 DYES 0 NO
•
RECORD DRAWING
a permaner.t record and must be accurate rno descriptive enough to re•focine in the need of mabnsaance activities and future development. rypi,:al Reccrd
. .: ,. .': s• •:r:v:unenta4.r 5 4-tyou: Sup ot,mo tank:°cation V;rttn;t•r„w reeerve dramber.. a•x,sang and f ropusrat buddmgb Iocatwri df wells.w•atcrbnes
-4 ,.crt+.r:c.r•. •I c.iC rd et m6vitenan<.a access ptants. Incomplete k. ..^aver r•rrw,.,r. au au:Ntiond dulays:n final a, c....•.t . .y e y rLproval and related permits.
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l45d444 A,
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?fn. _ s, cSI); £� S 4 �v. Q1.
1124
69 h2464-il- ,j am-F`£4,
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
'NSTALLER DESIGNER! ENGINEER
rtrfy that I installed the system in accordance with I certify that the system has been installed in actor-
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
an t Mason County Public Health and meet all State myself and Mason County Public Health and meat 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 and attached Record Drawing is accu ate. form and attached Record Drawing is accurate.
Signature ....,6ezvyt...ccreD,,r:,
- of \ .gs,
Printed Name cf Siantne / :.,
•
MASON COUNTY PUBLIC HEALTH . d',1- Voill/V
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' `:-,e undersigned approves this Installation Report and - ? DYOEO4WAI E
and Drawing on behalf of Mason County Public LICENSEC DESIGNER
;>IteF_s °silo,
Cjc g-1Z. I'( —z3
i;„,.o nv,ronmentat Huai!;)Saecialist Date ,slim:p signature and dates
•
THIS FORM MAY BE SCANNED ANDAVA{LABLE FOR PUBLIC VIEW:ON THE MASON Cr)UNTY 1, EB SITE Upcatr..0.2;4Ot6
PPROVED
N0V 1 6 2022
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