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HomeMy WebLinkAboutSWG2017-00380 - SWG As-Built - 9/23/2022 f Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 16t.1-0O3 $O Parcel# / 2. 168 - 78 - ?O6C. (o Applicant Name h aa, Subdivision (Name/Div/Block/Lot) Applicant Address r / £ 1/f �— L.d T'C c f Sri°'t Z.S `% City, State, Zip C- Q Mei. " Installer Name -1‘ 4ip on( '..+ Site Address aPl J V fivey,444 cf r Designer Name ,1-1/0 ,�;� 1 INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other ASystem Type 6-1 As tO Pretreatment Type oyC >5 ft.from foundation? - - ❑ N/A 21499!: N6 No" >50 ft. from wells? - •- ❑ i1 \` ❑, E134. Z >50 ft.from surface water? - - ❑ `%` . / HCleanout between building and tank? - - 0 ❑ •. U Tank baffles present? - - 0 2 0`\,. ' d24"access risers over each compartment?- - 0 CA ❑ I W Effluent filter installed?- - 0 r' El tank size Nra gal Manufacturer / l +xa-- a D-box water level and speed levelers used? - - N/A ❑ YES ❑ NO QO Manifold/D-box accessible from surface?- - 0 0 in Check valves installed? - - ❑ 0 62 Transport Line Size I Schedule/Class id? /A) 4 Bedrooms installed (check one) ❑ 2 j]3 0 4 ❑ 5 ❑6 0 Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO >100 ft. from wells?- 'ee14 ribir ) ❑ - 0 El W >100 ft. from surface water? - - El ® 0 ILL. >10 ft. from potable water lines?- - 0 ❑ 0 Z > 5 ft. from property lines and easements?- - CI © 0 12 >30 ft.from downgradient curtain/foundation drains?- - ❑ [/7 ❑ ❑ Drainfield level and observation ports present - - 0 0 0 ❑ Graveless chambers or ❑ Clean gravel used? (check one) afttie3.J Proper cover installed over drainfield?- - 0 - 0 0 ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ZYES 0 NO • Pump tank size IOW gal Manufacturer fwAtimv--- • 24"access riser(s)and accessible from surface?- - 0 J2I0 ~ 121 0 I— a. Alarm or Control Panel Installed? - - 0 2 Control Panel equipped with Timer/ETM/ ounter- - ❑ la 0 M 0- Pump installed in ❑ Bucket or On Block or 0 Other n- Pump Make/Model /Ae1OWhs..4 ❑ Floats or 2Kansducer 2 a Tank draw down in/min Pump capacity p-6444 gpm Squirt Height i ft Pump on time 64.4,. Pump off time f �Cf t.t Daily flow set at 3'6-0 qpd 1 Updated 9/2112018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES p/No If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El 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,cieanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. A.5_ 40,14- 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 kunty Public Health and meet all State myself and Mason County Public Health and meet all and Maso Fount),Codes.i State and Mason County Codes 1 further - ify that all ' . , -tion contained on this I further certify that all information contained on this form an. - - h-• ': •I LI . ••' g is accurate. form and attached Record Drawing is accurate. /41MA Signal of Installer Date P iket, c,PP Printed Name of Signee 2} MASON COUNTY PUBLIC HEALTHS C" The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: 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 8212018 • • ---------- VINYARD CREST RD • . 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