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HomeMy WebLinkAboutSWG2020-00420 - SWG As-Built - 1/11/2023 JAN 1 1 2023 ,,tP ` By 1 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBC1C-I-TaM1 APPLICANT/ PERMIT INFORMATION Permit Number SWG 1-0 20 — o`1"2-43 Parcel# 2-0 30 Applicant Name 77?4-c.y P4-L-� 2 Subdivision (Name/Div/Block/Lot) Applicant Address P�. -.:'_c'o_.` .ram Si° '= /_?!< ,• -- r 2 City, State, Zip 74< Gi 4j>;, ��,4 /�,,r; - Installer Name T4,--) ` �,G,z,�1,,,44, Site Address 1 9 0 S/ G�G�o�J —,v Designer Name %1/t,.r 4-__- -s,, - / ,ao.:�r✓G_ INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other System Type_ /,nr,vivi Pretreatment Type >5 ft. from foundation? - - ❑NIA ❑YES 0 NO >50 ft.from wells? - _ .- __ ❑ N ❑ >50 ft.from surface water? - -- - ❑ Q ❑ QCleanout between building and tank? - - ❑ 0 O Tank baffles present? - _ ❑ N ❑ 1 24"access risers over each compartment?- - ❑ 0 U.Sa. Effluent filter installed?- .- ❑ 0 ❑ 69 Septic tank capacity(working) \4c' -: ____ _gal Manufacturer H.,_. C --Dbox-mfater_levei and speed levelers used? - - aif'!A ❑.YES—— U No J _ O Manifold/D-box accessible from surface-,_`_ __ _— 0 0 co" Check valves installed? - ----- r th e= a •Transport Line Size Schedule/Class - Bedrooms installed (check one) ❑ 2 ❑3 r$4 El 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A Ei YES ❑ NO ® >100 ft. from wells?- -- - -- - 0 ❑ 0 i� >100 ft. from surface water? - - ❑ 0 0 g: >10 ft.from potable water lines? _ ❑ ® 0 - >5 ft.from property lines and easements?- 0 I71 El C'e >30 ft.from downgradient curtain/foundation drains? - - ❑ 0 ❑ Drainfield level and observation ports present - - El 0 ❑ . ❑ Graveless chambers or Q Clean gravel used? (check one) Proper cover installed over drainfield?- - - 0 El ❑ Pump tank setbacks consistent with septic tank?- - 0 N/A 1-2 YES ❑ NO • Pump tank capacity(flood) /200 gal Manufacturer L• d, < 24"access riser(s)and accessible from surface?- . - 0 El�� Alarm or Control Panel Installed? - - Li 0 0 g Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ 0 , Pump installed in 0 Bucket or 0 On Block or ❑ Other tt n- Pump Make/Model e.-_e.\l.^_..,- '-,1 a Floats or 0 Transducer • Tank draw down 3. in/min Pump capacity Cal.r-- gpm Squirt Height `J'•o ft Pump on time /. /,,,,;, Pump off'time G.d 2,-c Daily flow set at `/Bo gpd Mason County OSS Installation Report pg. 2 Parcel# _ r ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - ' ❑ YES tom' '�O If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - ❑ YES2 ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance ar.ti.ities and future development Typcal Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,tycnth arrow,reserve drainleld,existing and proposed bu:Idings,location of welts,waterlines, wells,observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final inslaflatien approval and related pennds. Si�7i `jGl ti,L /mac Go/? ��.c .r..✓ ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERi ENGINEER I certify that I installed the system in accordance with 1 certify that the system hes 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 moot all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes /further certify that a/i information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate_ a Signature of Installer Date . f.f? , • Nall-n Prin ed Name of Signee i111ASON COUNTY PUBLIC HEALTH 2 508 ' A The undersigned approves this installation Report and • r117 (3` Record Drawing on behalf of Mason County Public • . � Health: ( (1712-15 V-6111 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 t/pdared al21'2o18 r g 1 Y Y I P ' �$ N `m 6� w S v 4 » 2 a 1 1 F g !i o J i , ;WI s ,s_ a 6 u 4 M Q c 8 r( r Pi 2 MZao .�,- ® ; i $ �$ go 6J $ > b,b000I1 ME2i H `I b 0 Q\I a , a r1 d i S o .� 8 J 0 i ® < ' i S b t 4 ` ^HI i Nsy 's R id - W J :b s � �\ fs H E c N� � w 9 Q �.. al ki m� a 8_ pe 7 W0' a u V Vo u 1 '�y E o °o a o 33 al a�i 4 ''t 2 . 4 _ ;n t cli< U N j_ ----- _ _ --- 1 c c i ts 1 e � � 4 N Z .sal --7 ►�1 / ¢o O , ry 1:4- $ w h IN I o 7"/ P4 ,1.), r r 4. r .• '� v a 'b APPRO E m �• �. o ;< off © 1 i,...--- -.411 . .l,1,N3'y'•1 MASON COUNTY ENV1R0 DENTAL NEATEN /- - - w RET W o 1 0 a �V/ to 4. : • )A� U z 4 - / 0 v r 14 / ! 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