HomeMy WebLinkAboutSWG2021-00608 - SWG As-Built - 8/22/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2002.1 --&6669` Parcel # 32101{r- SK — e•o O? I
Applicant Name ..L -711c faKe._ Subdivision (Name/Div/Block/Lot)
Applicant Address 42 U_,,� E�-- � v , ,,�
City, State, Zip ( to / 41, 1Q- Installer Name `L�^�lr1 "!<
Site Address --3 1 c ,J, e._. P'7- -' Designer Name Ik,k{ verso 1
_ INSTALLATION CHECKLIST
Full System installatci L ?a •r.(s 0`* _rains eW Gnty ❑Repair 0 Oth ,-J++TT System Type ram$ _ ❑_T il_ Pretreatment Type AV'�W4WW __-
>5 ft. from foundation? [] NIA YES 0 NO
>50 ft.from wells? - 0 Ne 0
z >50 ft. from surface water? - -- - •- - - -- - 0 ❑
N Cleanout between building and tank? - - - - -� L� ❑ 0
U Tank baffles present? - ❑ I ❑
I•= 24"access risers over each compartnmen:7 - -•- 2$.2Q- -L 0 b- 0
a
W Effluent filter installed?- - - - - -- - - - - - - '� �►' '
Septic tank capacity (working) 'S z :-_,,a , c "i•.. _ - �1
0 D-box water level and speed levelers used? - - - - - .- - - •- - -- - - - - ❑ N/A L YES ❑ NO
IG O Manifold/D-box accessible from surface? - - - 0 El
4)2 Check valves installed? - - - - - - ❑ 0 0
in Q 1'
2 Transport Line Size 2 _-_ Schedule/Crass-_ y __1lb
Bedrooms installed (check one) 0 2 263 ❑4 ❑ 5 06 ❑Commercial/Other
>10 ft. ro,-r foundation?• ❑ N A DYES ❑ NO
C1 >100 ft. frorrrwells? - - -- L<; K ❑ -
--I >100 ft. from surface water? • - )i ❑
uJ i!s. >10 ft. from potable water lines?- Er C� 0
=> 5 it. from property lines and easements? `I 0
> 30 ft.from downgradient curtain/foundation drains? - - -- - -• - •• - - - l ❑
Drainfield level and observation ports present - - - - -• - -- -- -- - .- - _ ❑
XGraveless chambers or ❑ Clean gravel used? (check c:"e)
Proper cover installed over drainfield? 0 A
le ❑ i
Pump tank setbacks consistent with septic tank? - + ❑ N/A X YES ❑ NO I
Pump tank capacity (food) -3 gal Manufac firer 5Oc ___-_ �,[
24"access riser(s)and accessible from surface? - - - - - - - - ❑ i� 0 •
Alarm or Control Panel Installed? - - - - - L ❑
Control Panel equipped with Timer/ ETM i Counter- - - .. - - - - - - -- �/r;"--- - �/�/�'��� 0
f = r, 0-. ei(;cn or : _ CJ;.^ar�IG.�Y/� f I� ICJ S• 1' ✓LLci f
'� Pump installed in ❑ Buck tT ta; � i
A y MGV�g'tI) 0 i I � Floats or ❑ Transducer
Pump Make/Moos 1
"
t3. Tank dray;down 2 _- in/min Pump cep �,ay. _%__--__..-c Squirt Height 3 ft
?� gpd on VineI Pump off time__-' E Vie.._-- Caiiy flow set at
Mason Court y OSS i�:shilaticn Report pg. 2 Par.-;el 0i; S�" 1/
ABANDONMENT RYCORD _
Were existing septic c- ,;<,,_..' -� - - - - - - YE3 [l NC
i', yes, pie:ase describe: _ '�1 45/ �1 C ---- i
i.
IWere components pumped cut arc.VVoperiy ac:I `,::u per VVAC246-?_72A-G:�GG? - - -• - - -u- ES C NO {
ammo
ECt.RD DRAINING
+i This is a dsrinanert mooed„Inc st c :ra cleser;.t:ve on.-opt. •...... eu : of 1 denan activities and:stunt• c-ve�apment. Typical Record
t D-aw•rys cor::air :irai•!iolr!5 rr to.,_.. .., .!cut °•(-: �..�:•.:: '1 ;:m .e:+.�.1 e.g.. . ,.reposed build ny:.,lowt4a'er wells.watt•dmos.
........ ..e. ..
ecUs r.:.acrvaaoa F.c;__ deann�ts,arb c;hcr-tairftornm accu::•_o:,s i, ..•. .._•....... ,zi delays in foal+rislallaY.nn approval and rotated pcvm�s.
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�. �......._���... -- --, �,. ....,...�.,...._...___.._..._.___ -. ..._ ._.___....�. (�•i-t�.co�� Drawing Aitacrzd
I certify that I instal ea il:r, s 'ter.,:r: occordcr'i::e with - . ,.... . : --• ,,has bee,:instalied in acccr-
the.septic design s;amp&d `APPROVED"by:',:ason ! .. . ._ .. ... design stars. ed '"APPROVED' by
S County Public Heaith and that any deviatior,r stow n 1 .'t-:: . ,:, -Health and that any deviations
here nave been cleared/approved by both the desi:;or 1 shown :.... 'n U:::en cIearadrapproved by both
t and Mason County Public Health and meet all State I myself e,;'-::•la:::oil County Public Haaith and meet all i
and Mason County Codes. s; State ar;r, -.,F.v::n County Codes
;t i further certif,/That oil information oon:ained on i'i' 1 'i:-%:L' ':'_r all information contained on this
fora?and attach r'GCCrd(,;ravvi'rc is '�.`!nf),z_.4- -. ..%Y:;';...:P:-Jccrd Drawing is accurate.
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Sig Zit: istaiie^'
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Printed Name of Slg-m i cer, VA1
# MASON COUNTY •., .. ....• ._ y Sid .G� i �14i
i The undersigned r. ,J: , � 4 .,1+
Record Drat: .._. Ir+ninwEif�ruvERaonl
Health: ,! LICENSES DESIGNER 11
CAIQ L/ EXPIRES:09/te/
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Signatf;rc or t=liV,;'Gnri:bV. L:;H -._ ...... .....�.............. ._..... . .._st !3`' Ysignature and date) 1
ucdarea:�rztrzo:e
THIS FORM MX.'BE., a,, ., _A.-.: _._ : - . . -:E MASON COUNTY WEE:,SITE
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