HomeMy WebLinkAboutSWG2021-00650 - SWG As-Built - 8/22/2022 4,1, :g
Mason County OSS Installation Report pg. MASON COUNTYi1�1.�EA1
`��>
APPLICANT/ PERMIT INFORMATION pe
i
Permit Number SWG � Z4-'' /QU�o�0 Parcel# /Zz /(, S / O 0 /0
/�
Applicant Name !341A- W At Ke r Subdivision (Name/Div/Block/Lot)
Box / Z<// 22'/ /0 ter /0 9
Applicant Address ��ll C1r/ � �L��.�
City, State, Zip //�00": YLY- 1 ^Installer Name / Y.
Site Address 160 Ai /fie A44/tg-gi;pdtesigner Name II 04r4 yu' T&
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other ��P
System Type erGsS✓Iee 6 Pretreatment Type SA"'O UA'
ech
>5 ft. from foundation? - - ❑ NIA 0..YES ❑ NO� ❑
>50 ft.from wells? - - -� 0
z >50 ft.from surface water? 0 ❑
H Cleanout between building and tank? - 'li�-�$'�2r '� ❑
U Tank baffles present? - El
24" access risers over each compartment?- By -- ❑
LU Effluent filter installed?-
Septic tank size /2-50 qal Manufacturer i/ GEL/41-' 7-474 f L '
C3 D-box water level and speed lev ers used? - - ❑ N/A ❑YES El
�O Manifold/D-box accessible from ?-14-- - 0 0
mZ Check valves installed? - ❑ ❑ ❑
ca a Sc edu{e/Class
2 Transport Line Size
;f 5 ❑6 ❑Commercial/Other
Bedrooms installed (check one) Pi Ili
� G� C t, �J - ❑ NIA �}YEs ❑ No
>10 ft. from foundation?- _ 6 :: :+-- ❑
M_ , ❑ -
0 >100 ft.from wells? 7C'2-8 zu,� n�_- ❑
J >100 ft.from surface water? - ❑
Ill
4 u >10 ft. from potable water lines?- - ❑ CI0
5 ft.from property lines and easemen�e:y- ���
> 30 ft from downgradient curtain/foundation drains? - - ❑ ❑CI
0-- ❑
Drainfield level and observation ports present - - 0
❑ Graveless chambers or Clean gravel used? (check one) ❑
Proper cover installed over drainfield?- - El
TA YES 0 NO
Pump tank setbacks consistant with septic tank?- ,,��-// ❑ N/A �J
Manufacturer l�'� 'G �" 7�F/rc'
Pump tank size �Z�O qal
Z El 24"access riser(s) and accessible from surface?- - 0
t` Alarm or Control Panel Installed? ❑ As
a - g 0
2 Control Panel equipped with Timer/ETM/Counter- ❑
M
- Pump installed in ucket or 0 On Block or 0 Other
n' Pump Make/Model 141 y'CLS M E 3t t2kloats or 0 Transducer
IL Tank draw down
2-' in/min Pump capacity 60 qpm Squirt Height ft
Pump on time / m Pumpoff time Qj �1. Daily flow set at 2 (Q qpd
n updated821/2018
Mason County OSS Installation Report pg. 2
Parcel# �Zz/6 —C� — bD
ABANDONMENT RECORD
- R, YES 0 NO
Were existing septic components abandon as part of this project?
If yes, please describe: e/k-i fl.f2 ii io YEg NO
Were all components pumped out and properly abandoned per WAC246- 72A-0300?
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 8 manifold orientation 8 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 permits.
-e • 9 -wing Attac -•. '
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-
stampe
the septic design stamped"APPROVED"by Mason dance with Mason Countythe Public ic c He�h and thaw any de"APPROVED"
t oD"by
County Public Health and that any deviations shownh ns here have been cleared/approved by both the designer shmyself and Mason County Public Health andn here have been cleared/approved by all Ii
and Mason County Public Health and meet all State State and Mason County Codes j
and Mason County Codes.
I further certifythat all information contained on this
I further - . that all information contained on this form and attached Record Drawing is accurate.
form a,d att. hed Record Drawing is accurate.
✓/ 0 3—2 Z 7---
I IC,!
Si• • f staller ate tf '��/
Ar
Tinted Name of Sig � . r w.,v ;••,r
MASON COUNTY PUBLIC HEALTH r'= ' s
The undersigned approves this Installation Report and 4•
' J. (.�•�
:L' StUJ3I:
Record Drawing on behalf of Mason County Public pDA1‘.1 J.HUNTER
1';�,t'�fit'ti 1.)12§i �1V' '..
Health: � �5' �
1,11 7-& `
Signature of Environme tat Health Specialist Date
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2112°18
3 4
0000000000N
'
73
n p � •P > m > rn m m o Do
> AQ -0 X 0 X X x -1 -1 o
p- 0 v cn co cn m O 0 J ,
5 m -I -I 0D JOO O i S O O r
D .
-1 Fri 3G OOO Z< Z p - n cn zc m
pHm -I -1 vn J m = m 73�
_ r m 13m zm O n < al p z0 �
0
0 Orn O C) Cco
- > O xco . >n O x m I
AZNz 0z = z mO0O AN D
I
A m m 7
c o 2 o m 4, \,
c= pCcn • m -I y
DAO •
\
n
O K O mO m• p / \ \m p C m
cn X H p Vm m n 0 / / II p p Z m o
c a O r-
-, _1 p / O . Am o
O m p m• m c / \
0 0
p p /
73 * O
m z m / ��a� // �'
0 A
8 / N
O , �
* `.\
Q •
X �' N D.
r O O
Z D
m Z
\ n
O� 4 O N O
A Z NJ C
{ C.
rn N
Z n_ 1 ' 1
E
0r
70
O m
v 0 = O x N
n D N
c co
2
D › oC N
A z N
z DW � �
N rTi
D c) v+ N O rpZj
at r-
X = < (/�v
3
r D
O OD
3 0
p
1. 1
in m tfi
Z Q
o
= VI
m Z m _1 Z
m D o
r ? D m A
o p
> O r 0 p n
'*' 0 -1 O O
m m D A
I-
,, A \ -n
• O m j r
3 m Ll 4 cn
N 0 S
� r N
S
8
O
N
m
0