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HomeMy WebLinkAboutSWG2022-00576 - SWG As-Built - 1/13/2023 �d :i . ,;on County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION i Permit Number SWG 2i0 2Z-'0f, Parcel # Lf-Lo0z_ 1q-OOr02b Applicant Name joighl tNIACROW Ib8d abdivision (Name/Div/Block/Lot) Applicant Address I 2.52.0 isrr�. Vf, /�Y /O/ City, State, Zip 311 WA 405611 Installer Name 'A�"IF b ;f�4rj,t. Ic- Site Address Designer Name e y Wa k- INSTALLATION CHECKLIST Full System Installation 0 Tank(s)On' 0 Dr=+rfieid On,y 0 Repair ❑Other System Type /'7 NZC#t Pretreatment Type t >5 ft. from foundation? ❑N/A ..i YES ❑ NO >50 ft. from wells? 0 0 . 2 >50 ft.from surface water? • - - - - -. _ _ _ _ _ _ - 0 ❑ 5 Cleanout between building and tank? - _a 1 --_ Tank battles present? - El0 p h132023_ - - a. 24`access risers over each coin art 0 =W Effluent filter installed?- J� N►EN.ALHEALS +0 0 0 Septic tank capacity(working) 12 A gal JBJufacturer D Pacji4491wr 59411 1'5 CI D-box water ievel and speed levelers used? U-i� N/A i YES ❑ NO OO Manifold/D-box accessible from surface?• 0 i in z Check valves installed? . Qa - 0l' E Transport Line Sze 2 M _. ScnEdule/Class 110_ � Bedrooms installer: ;check one) 0 2 3 n 4 >10 ft. from four:dat.7n?• - - - _. {��`"' - fl ❑�]5 n 6 DCommerciall !her 100;t.from wells?. ._ - - - - U tJ ❑ NIA YES ❑ NO ut >100 ft.from surracc water? _ -IE _ ❑ 0 f z >10 ft.from potable water Jines7• - - - - -_ _ j ���_ 0 ' 0 > 5 ft. f-arr, ,-oceny ti;,es nil easements" it 0 30 ft. from do`nmoradienii curtain/founds 1.>�diai,,,?. NO o Drainfield level;end obser{anon ports present . -• _. ❑ ! n Graveless chambers Pr IS C:ean gravel used? (check one) 0 ___ .)per cove ;not.Ilea overt cra,r•.field? _ __ ❑ Pump!attic setbacks consistent with septic tank? 0 N/A Vj YES 0 NC z Pump tank capacity (hood), 12.75 gal Manufacturer I25 �. V 0 D P u ,Q 24"access rise.(s)and accessible from surface?• -• 71 0 a Alarm or Control Pane! Installed? • - - - - •_ 1.1 Control Panel equipped with Timer/ ETM, r ❑ 0 0 i Courtef 0 0 O. Pump installer :r j Bucket or ei On Block or 0 Other i Psi ump Make/i1/Iode: e �l� 2 Floats or 0 Transducer a Tank oraw aewr, in/min Pump capacity Q t . H ii gpm Squirt Height -4,5 __ r• -1 Pump on time_1'��i Pump off time 1'f>� Daily ^^� _ f.�___.___ flow set at oG Q 9pd 't^ son County OSS Installation Report pg. 2 Parcel r; LfZ' 14 ' 000zo ABANDONMENT RECORD • ••irc exfsnng septic components abandoned as part of this project? r YES NO please describe: _ ,!ere all components Dumped oul and properly abandoned per WAC246-272A-0300? - igYES 0 NO 1 RECORD DRAWING This a a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development. Tyu,par urawros-:untain rid-nfietC 8 manifold un e emi .ur 6 IaYcu;.Set pun:0 lair loca:wh.north arrow.reserve(Paintieio existing and pPo Rent:_pGsed casf• �ngt: location of weft �na4rrMte� wets observation ports.cleanouts.and other npintenanc•e access pants. Incomplete:Record Drew ngs may create acorti(na!drlays:n final xistaiiabbn apornva=and r,,,atee pe•mrtc. . PPS VEL) ,���NcoU�AN 31023 YENVIRpN Jaw MENTAL HEALTH tar Record Drawing Attached CERTIFICATION OF INSTALLATION ' INSTALLER DESIGNER/ENGINEER cerdity that/installed the syst m in accordance with I certify that the system has been installed in accor- the septic design stamped 'AP�ROVED"byMason 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 aft �•rd Mason County Codes. State and Mason County Codes • 1 further certifythat all infonnatirfn contained on this further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate i I51a s++ ur Lauer Date i r P':,lrea Name A(Signee /s� vXi^sti v�VA 0 cii- ..r. utl*-1 k + MASON COUNTY PUBLIC HEALTH r' ° ,. /ire undersigned approves this Installation Report and r� boa, 1)\A Record Drawing on behalf of Mason County Public r O�LICENSE DESIGNER ���+,+� He �r� �������. i �����1 EXPIRES 05i1oi itj ?J—CICC--' . \ .1-5--427) •�'9 .a.iP- !Environmental Health Specialist Date _ stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE '-c'deuv:arzt?CI" RECORD DRAWING continued I <---- L 1%11 ,,tko)? I ^.1'i N °/ 4PPROVE ,, © o „,, ..„ 1 , ,,,4soN 0uNT JAN 13 2023 ` ileiy ENVI / Jg RONMENTAL HEALT r / / 1 i ��'W fik<#eli- i rLh \ ,- res i ,..i.P1A4 Pam' v / csi,./A ti! 1) }Low w by - W Oa/461,A .,C,,,, Peeauv(.. 1 01 ___-----"- ----- I-Ifi"til kit ....----- e •.12 . 1.1 _ .. ..........''' NMENTAL HEALTH 2023 ,AlouNirAyNEN,v1IR36. . PP R 0 V ED i wAsoNc . J 8 IN (i.) CX'.-..0 14,1 keS't JeA't!C.-to 1 5- L. I 0-,I6P 6 45- C-7) i 20 0 ? vt.i le AI Ge ivecile .e. . -"to ivic. ger c4o111 44 . • , Pt 2 ,.......;,) 1,.)04 5, /4,,, p4...) -40 t ii I it , • i A .. giv i : 1 . (q) CZ-tkcIto ) Vt.S4 44 i . or 11, 'I ) ... Lir? i A.Q• A II i'40 •P I jra" ! k• (?.) C I(4 Al 0 t4 0 'II i %,,it • I -.....-....-.......... ..-............., g eat 7.--606 , ir CO Ti4 ifr 00 1,- 343 --,. .. , 1 "P'Ct Y Aim k - •,1 f I . ity 41' 1 1. ,,,,, .s.,,v ,, „ 11,v.:,-,.. i 4f SE ESITA 4._ /a. 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