HomeMy WebLinkAboutSWG2022-00576 - SWG As-Built - 1/13/2023 (2) d
.'.1:7on County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 20 22,"'COON. Parcel # 42402 I'4 o4ow
Applicant Name (1Ik1Pw Ikea risiedbdivision (Name/Div/Block/Lot)
Applicant Address 12.520 d. Of. Hwy %4/
City, State, Zip Sile WA %$8'J Installer Name C—ResaUtieu
Site Address SIFT Designer Name VVQ.i „e
INSTALLATION CHECKLIST
XFull System Installation 0 Tank(s)On ❑ Drainft O ❑Rnpair ❑Other
System Type__?Yel39.44C 1 rerlatt
Pretreatment Type
>5 ft. from foundation? 0 N/A ::i YES ❑ NO
>50 ft. from wells? - -, ❑ 0
>50 ft.from surface water? • - _ _ _ _. _ _ _ _ _ _ _ _ _� ❑ ❑
5 Cleanout between building and tank? - p ill_ 1_ __ ❑ 1 CI(.; Tank baffles present? - ❑
4. ?.4' access risers over each compact 13 2023_ -
_
❑
• U. Effluent filter insta!1ad?- - J� MEN-ca- 130 0 0
S(j tlN-N ENw 0 0 0
Septic tank capacity(working) 1?.D (leii JM Saab b P CIPiei 'se$rzef5
-....CI
..1D-sox walei level and speed levelers used? -
N/A YES ❑ NO
OO Manifold D-box accessible from surface?- 0
QQi .
Check valves inalalled?
Transport _ire Size 2 0 0
ScnEdule/Class !
Bedrooms installer ,check one) 0 2 113 ft.❑4 0 5 0 g 0 Commercial/ !her
>10 ft. from foundat.•)n?• fl_ _
} ry >100 ft.from wells'?• ._ _ s -fk U f ❑ N/A YES ❑ NO
cu
ace water. . J.&N- 14-2023 - - • 0 Ar 0
ti >10 ft. from potable water Bines7- - - - - -_ - _ - _ - _ _—I- El> 5 ft. from prUcerty iit,P•g land easements'
_ 0 ❑
I By '
-"" > so fi. from dawnoradienIIcurtain/foundaN_r •J,0;,,,?• u -_ - r10 0 0
1
Grainfield revel and obserlaron ports present ..
n Graveless cr:ambers t r 'V C;ean gravel used? (check one) ❑ ❑ d
-)per Gov:-..-fastelied ever cra,nfield? 0
rump;auk setbacks consistent with septic tank? • - - - _ _ _ _ _ _ _ _ • ❑ NIA J
� VT ❑ NO
Y Purnp tank capacity (Hood), 1175 gal Manufacturer 1250 5:igul1a
Z
< 24"access nserts)and accessible from surface?- --- - - - - - - - - - - 0 0
ti Alarm or Control Pane! Installed?
Control Panel equipped with Timer/ ETM / 0
�`� ❑
Cauntef 0 0
- Pump installec :r 0 Bucket or ,b On Block or 0 Other
i
t1 Pump Make/Mode: ; 4 tom,
Floats or ❑ Transducer
I t1 Tank craw aerrr In/min Pumpu "1
- capacity pacit ` __-9pi r 5quir! Height '? r- 40
Pump on time 1 s 2 - Pump off time 1406 , I
-` —_--- Laxly flow set at 70 .1;Pc I
I
•
1
.,.,, ,son County OSS Installation Report pg. 2 parcel �?-G�OZ" (y Od°Zo
i.
•
ABANDONMENT RECORD
Io existing septic component,(, abandoned as part of this prolec
YES El NO
please describe: l•
' acre all components pumped out and properly abandoned per WAC246-272A-03007 YES
NO
RECORD DRAWING
This rs a permanent record and must be a4curate and descriptive enough to re-locate in the need of maintenance activities and future development. 7yu;;a,Rec i
Drait,r•ys,untarn o,..rntelc&toanrfpla onentekon&layout.Sept..oump tan.:ocatiofi.Korth arrow reserve dramliero exsnng and;!;retie observation puns.cleanouts.and other maintenance access pants. IncornpteteRecord Draw;n;/y may create eaainuna!delays m final ntsai;alIn puv3 ne fus e,trrnnacs
3 A ul2'ea pe+mrt,.
ppR
� �F
n soy JAN 131023D ,
CCU T Y,viRpNMENTgL
Jew HEALTH
iiirRecord 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 Ony 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 Heald,and meet all State myself and Mason County Public Health and meet all
�"ri Mason County Codes.
State and Mason County Codes •
1 further certify that all information contained on this
is accurate. I further certify that all information contained on this
form and attached Record Oraw9n
g form and attached Record Drawing is accurate
1 51a
-man, taller I / 1
Date of
• •�
ronrYamep/Srynee 1/5
I 1'- iv4Shy9�i )1
\(/
rt.0
MASON COUNTY PUBLIC HEALTH b .
`\\\
undersigned approves this Installation Report andtP Record Drawing on behalf of Mason County Public 0O LICENSED SIGNER ��`,�+/ ')
He . : rm. a�� la�amma
EXPIRES 05rt01 "` ,r
__ —13—�3
a,gr at n- 1 Environmental Health Specialist mate
stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE vc4a4'a ar2'2018
RECORD DRAWING continued
I
V
(--- -.-- 4------
Sir
/
10‘11/4 ,allA 1 Yi
41.‘t I
LP
ft) ..
°�l APPROVE .,.-')
Q .IqN
° '.L,6OA,cc�Nr 3 2023 �'F.
p � YFNVIRpNME
Jew NTA�HEAL i;-
/ 1
l �W
P14(#'e
"3\1
E�i;:u7..- "11 .. .�
�
I1 Vj/i(6114/4V
D ita w w by
q141__. .51-;,
0
. 1,t % 12 �I '
..
f - - A
z 3
cou
4 ..P'PROVE1
JAN ,
r,�q�N 1 3 ?0?3
( x''' ,^'el 4C Ps e r1FC JB RONMENTq�.-HEAL Ty
--� �I� H
ydlle„r C�wcr�i SLl 0 l'itPGLS-
rt q/ a d-oin 4,,
�'.j I-)eo cf // , Pturyp
r-�t/ I
4-QIJ 1c
RQ(i(1,a ) Vlst, a,1 ,
1r },i, A
C_ 1:::
p ,21
f ;Sti 9i
id
" a
th
Ts p,i.F• 143 lTJT
Sbem si l {��
%..-i VeJ IVe 6 e 4 F -A / CxniHE , N�
"Nag
p : & I Is
ita_,..1.,,,,i 6.1) -`6=--:i_
SU ' I ite n. 4 Qiuks-
�V is IMf rT p`L� /
4—'Abe • ��
�..Su us' lo,Acsbit, I of
kJ u tAtclis 4 H .: . : ' r
!� Pt're„t 4g fv �j .�'CJ�!v o' ..1 _. . 'Ss'J�
/ '' ; SO'