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HomeMy WebLinkAboutSWG2020-00292 - SWG As-Built - 7/20/2022 (2) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2 02.O-0O2oi,2_ Parcel# -5202.t SI 0oo0Le Applicant Name TOD1D Wlt.yAQ\)\Sk ..4 Subdivision (Name/Div/Block/Lot) Applicant Address 2-103 I�Av-i $ovr 4 City, State, Zip ol,1 WI►A-, VA T SSD Z— Installer Name -tGSSct .. T o Designer Name -tON Gc r Site Address I�tG� Wt4l-K£IrZ C�+AR►C R� g INSTALLATION CHECKLIST D [Efull System Installation CI Drainfield Only Only ❑ ❑Repair p ID Other co System Type (Ill_ETA)Dp1L1 Pretreatment Type N N �; >5 ft. from foundation? - -- El NIA R ES El NO �` >50 ft.from wells? - El ET ❑ CI • >50 ft.from surface water? - -- 0 Er 0 Z - Er El HCleanout between building and tank? ❑ 0 ✓ Tank baffles present? 0 Ga' aEr El24"access risers over each compartment?- _ 0 W Effluent filter installed? ❑ Er ❑ N gal Manufacturer .50L) .)D LI ►nENT Septic tank capacity(working) 1 ZOO -,� NO 0 D-box water level and speed levelers used? - - I�""A ❑YES� ElQO Manifold/D-box accessible from surface?- ❑ Er ❑ oD Z Check valves installed? ❑ 2 Transport Line Size I. " Schedule/Class '-10 Bedrooms installed (check one) 2 D-3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- ❑ NIA Q'SIES ❑ NO CI >100 ft.from wells?- El 0' ❑ W >100 ft.from surface water? ❑ Er ElLL >10 ft.from potable water lines?- El Z > 5 ft.from property lines and easements?- - ❑ Er ❑ d >30 ft. from downgradient curtain/foundation drains?- - 0 2' ❑ o Drainfield level and observation ports present - - El ❑' 0 ❑ Graveless chambers or [Clean gravel used? (check one) ElProper cover installed over drainfield?- - ❑ la- Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tank capacity (flood) 120 O qal Manufacturer SOUND -c r -cr T Z < 24"access riser(s)and accessible from surface? 0 Er Elf- a- Alarm or Control Panel Installed? -2 Control Panel equipped with Timer 1 ETM/Counter ❑ 9 ❑ - D a. Pump installed in ❑ Bucket or Ern Block or ❑ Other d. Pump Make/Model rnc-DetJ .i NADIAE .onl I ❑ Floats or ❑1 ansducer 2 0-a Tank draw down r it in/min Pump capacity 10 gpm Squirt Height A-1 -14 ft Pump on time% /0 S&- Pump off time ChNi/V 50 SEC Daily flow set at Z tt D gpd Updated 8/21/2(118 Mason County OSS Installation Report pg. 2 Parcel# 3'ZOZI 5' I oboe ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ONO 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.Septicipump tank location,North arrow.reserve drainfield,existing and proposed buildings,location of welts,waterlines, wells.observation ports,deanouts,and other maintenance access points Incomplete Record Drawings may create additional delays in final installation approval and related permits ` ❑ 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 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 an attached eco Drawing ' ccurate. form and attached Record Drawing is accurate. Signature f Installer Date • 1111 4 J • ri-4LT- •.11 Printed Name of Si nee i 9 • 11 " a wAry 1 • Q•� Vi`I MASON COUNTY PUBLIC HEALTH •1 �• 1 The undersigned approves this Installation Report and . .>' 1 -r�i • Record Drawing on behalf of Mason County Public i 5100347 �1I ore Norman Godat*• .... Health: i ����, • �, ,, / 1r 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 8I21/2018 Fir 1 `- `` ....\ ... //'' ``` • C")n on ` O'00l` C C= 1 0 MI k 1 2 O r N I tL n- :-/ f O n1n1 /it D r r D © q C V 0 / to o 1/ z - 1 I r o • t 7 / M •% ./ ', r*1 rT1 �, CD 0 V 0 pd --1 to o No / © • ' / Zr f- hb 4 1s , a fn1U o 0 i `#1•S s y In )::i. l•S z M rri (, Zoo stn-, 2 A rli :0 o�� 0 Oat C) C Z �°p•S O�2 r-r rT1 •. 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