Loading...
HomeMy WebLinkAboutSWG2021-00374 - SWG As-Built - 1/12/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 71,a-1 — tx),S7tf Parcel # lip/3 S) • QO Po Applicant Name R46411 /Va Subdivision (Name/Div/Block/Lot) Applicant Address $'art N vS 14a to f n City, State, Zip I4.ov4 ,;r- (4 t Installer Name 4--4e-f1wt 6 p Lint. ARc Site Address 2 VS Ail 10/ Designer Name 3t wt 4.11417 INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type—+ kc 0\A; v) _S Lt Pretreatment Type �_ `.- >5 ft. from foundation? - - ❑ N/A EYES ] Noo >50 ft. from wells? • 0 0 .< (. Z >50 ft.from surface water? - - ❑ Gil 0 ' _, H Cleanout between building and tank? - - 0 0 o C ✓ Tank baffles present? - - ❑ b '" d24"access risers over each compartment?- - CI a ti I Effluent filter installed?- •- El0 :1 Septic tank size / r1)' r gal Manufacturer �t i Sr O D-box water level and speed levelers used? - - NIA 0 YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ a ❑ QZ Check valves installed? - - ❑ 0 2 Transport Line Size a-t( Schedule/Class SA te0 Bedrooms installed (check one) ❑ 2 ❑4 0 5 El 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 2/YES ❑ NO CI >100 ft. from wells?- - ❑ 0' 0 .1 W >100 ft. from surface water? - - ❑ (Z ❑ u. >10 ft. from potable water lines?- - 0 ® 0 Z > 5 ft. from property lines and easements?- - ❑ ❑ ❑ > 30 ft. from downgradient curtain/foundation drains?- - ❑ 0 • Drainfield level and observation ports present - - 0 0 ❑ lg.Graveless chambers or ❑ Clean gravel used? (check one) ro r cover installed over drainfield? - ❑ Jul 0 Pump tank setbacks consistant with septic tank?- - 0 N/A 2/YES 0 NO ZPump tank size '0aW gal Manufacturer ttsr < 24"access riser(s) and accessible from surface?- - 0 12" ❑ F- Alarm or Control Panel Installed? - ❑ � 0 a - • Control Panel equipped with Timer/ ETM/ ounter- - ❑ 101 0 a Pump installed in El Bucket or On Block or rikOther flow T.. 2 Pump Make/Model ©f-eVt to pp 'SDJ of?— 12loats or ❑Transducer a Tank draw down P 11, in/min Pump capacity 34 gpm Squirt Height(7e2 (o ft Pump on time l t ti, Min, Pump off time , /& Daily flow set/at c 70 qpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 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: Drainfield&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 pem'..its. pmitimt, ❑ Record Drawing Attached 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 all and Maso ounty Codes. State and Mason County Codes I further c ify that all inf rmation contained on this I further certify that all information contained on this form an ttached Re Drawing is accurate. form and attached Record Drawing is accurate. Sig re of Installer Date gefihiee iff UFA-- Printed Name of Signee °4 z3-z� MASON COUNTY PUBLIC HEALTH 510001 The undersigned approves this Installation Report and o JIM HENRY use, Record Drawing on behalf of Mason County Public EICENSE ZESIG tJER Health: EXPIRES: 08/11/ , . la_Z3 Signature of Environmental Health Specialist Date p (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated8/21r2018 1/5/23, 11:33AM https://office.smartgovcommunity.com/Parcels/ParcelList/Print Parcel List 2 Records Parcel Number Owner Primary Address 422135000003 PHILLIPS JR RICHARD G 23830 N US HIGHWAY 101 422135000900 NEFF ET UX RANDY E 23832 N US HIGHWAY 101 https://office.sma rtgovcommunity.corn/Parcels/Pa rcelList/Print 1/1 _ rw z m T, d \ \ \ (n D m � y \ \ 8'SSZ \ tcP. ,s am•� � ZI ) N, I '1 /,' D7 . w T \\ CcDCD \R FR\C ...... ,, 7,.... ..,s,._ , ....... ., . ......„:„....„- ,.....3 _, „7:-.... O r LP D I ...• 00 73 0 I �pVF� \ y ZMm co q% / \`\ \`\ \ Z r p to \ \ Z 2. *."'.. ..". -". 1 =.111100- - ,\-"Ar i ir n IllikeI ...., .". '., ..., ., ..... ....,. :- 0 O c � xl (nrnJcrnn > mx -aCMZ < (nnC -n O M2rnm I?Cox C -nD -I I- 3 - cm •-'IZ m � mc„ cn u zi D Y 4, z0cr -. Z 7) in- 0 CD ' 0 Dm � r Go0 m ZZN• O = xt N0Z ii O II N N HI • moo, "Yn Z= z n - �.cD ' "P�"9T� v, Q o. —n Ogg f • O C - ^ (D 3-, 0'Z NJ 4S- p n z al VI � Xw ..(; A; ��S 1 H m H�//�( ���m z m • CZ lij ' 39' DRIVE — — N_^'v- W \ �M�II : ' 1- - rn m w -+ n v 1 \ n m ia O 3 _ I • w p O \w r < r D O O = 77 m N xi0mx n \ A 111 N m Z w W I p ti r (Si Z p D A c Tmw � II N n /� N T O N T 1 A 2 m O• D M z O m > o � A A -G p N Q n • (� yTt O w 171 m D 0 D co N N D ZJ `•,i �j p A _ .�_ p co7. o �z z -< oo m C z Z crn n oo 0' 77 c.d., o w z 70 C 1 < � NJ -o2 OO n D Z Z o O pA r- n H O OP p 2 n nm O =C o73 O z Z -o Z o�D Zm0 • m-n rn D n n O 0_ nr Z O D" 0 m Z Z°° rn Qo iam O o r n f N N NZ N 0 to Z 2 m pf!) N 0 m O m 0'n D 0 v Z mm°o y n z