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HomeMy WebLinkAboutSWG2021-00186 - SWG As-Built - 8/23/2022 1 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG • 2 ( - no ( 6 Parcel # gzJ/6( - 75 -go /O/ Applicant Name JDrA\/ i p P-cH1 `1 Subdivision (Name/Div/Block/Lot) Applicant Address cl50 &A.,,c,tittiv7-067117aZ City, State, Zip N(ON/0.1J, W4 9R�. 17_ Installer Name v tip is i-+-P.,Y Site Address 950 r L.t!«lAvi-rv?L- ` A c .UIx Designer Name a,(� q(uc 'u, INSTALLATION CHECKLIST E.Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑ Repair ❑Other System Type Sk4,c4,k%4 —14resSufc. -�ccvK,i-- Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft.from wells? - -- ❑ [ ❑ Z• >50 ft. from surface water? - - ❑ El CI HCleanout between building and tank? - ' - El El® U Tank baffles present? - - ❑ ® ❑ a CI access risers over each compartment?- - ❑ R W Effluent filter installed?- •- ❑ 0 ❑ co Septic tank size I ZSO gal Manufacturer .-<,-N-,4 w 0 D-box water level and speed levelers used? - - N/A ElYES El NO oO Manifold/D-box accessible from surface?- - CI ❑ c9 Z Check valves installed? - - ❑ I ❑ oQ 2 Transport Line Size Z. , Schedule/Class Li 0 Bedrooms installed (check one) ❑ 2 513 ❑4 ❑ 5 ❑6 ['Commercial/Other >10 ft. from foundation?- - ,l N/A 0 YES ❑ NO O >100 ft.from wells?- - r - - CI [A- CI W >100 ft. from surface water? 15 - ❑ El ❑ it >10 ft.from potable water lines?- - - - - - ❑ ® CI z > 5 ft.from property lines and easement J- 2 8 20�� - ❑ El El > 30 ft.from downgradient curtain/found tion drains? -C1i'-'- - - - ❑ ❑ Drainfield level and observation ports pr -._.___ - - - ❑ IEL ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A b,YES ❑ NO Pump tank size t Z 6 I gal (t°c Manufacturer /+4ler-c-tc.-L- 24" access riser(s) and accessible from surface?- - ❑ RI ❑ ~ Alarm or Control Panel Installed? - - ❑ ❑ a E Control Panel equipped with Timer/ ETM /Counter- - ❑ ZI ❑ C- Pump installed in 10. Bucket or ❑ On Block or ❑ Other a. Pump Make/Model Z©_ - I57_ Floats or ❑ Transducer 2 R Tank draw down ) % in/min Pump capacity 3 gpm Squirt Height h ft a �1 Pump on time f i iS Ai. . Pump off time v[ 1"-1- Daily flow set at ?TO gpd Updated 8,21/2018 Mason County OSS Installation Report pg. 2 Parcel# qZ 114- 7S —10{ 0( ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES E. NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - D 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,Septidpump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cteanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. LA-Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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 Mason County Codes. State and Mason County Codes 1 further certify that all 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. OC ignature Inst Dat \Q`' yet r�A Iaj At tilkY tip: Printed Name of Signee L of, 1, W sh MASON COUNTY PUBLIC HEALTH p ; ' 11;1 The undersigned approves this Installation Report and js+�� Record Drawing on behalf of Mason County Public oar i iciwTHA1WE HALVERjoe'% Health: 0 LICENSED DESIGNER rZ `,)7 1 EXPIRES:09u16/23 Signature of Environment Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 �4S 1101 +/- O�� • A - > > Zoe cn 6 O - Z rn � rn ( . � ! 1 iv 0 D o � t ^�^�� o 0 Z C] .L N.) 3 K.)rt 7-- -- rn O —Fence - — —T -I p I 50' _I rn O A 0 - - _RESERVE__ - - - = CP x I— rni ; A E - - -�s>=wry - - - ] d Z d3, / I C\ i . i a.44 �m 6 g ,c¢ $ I d i > •''' $ C/• '). 1 1PP* 1r 6'Ft- I _,1 XK !� ,tea \'''.5:'° 5'�CD 1 & /aQ \s• X S i• t:i ,, II ��� \y rn I ! / sj. 0 \ , ..0 , . 4;1 , I C D -70 .m I 1 / rn / Z N..)�� — ^''oO i.? 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