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HomeMy WebLinkAboutSWG2020-00420 - SWG As-Built - 1/20/2023 1Re©Mll 71 c-C3 J A N 1 7 2023 T, Mason County OSS Installation Report pg. 1 MASON COUNTY PL ,IC HEALTH APPLICANT/PERMIT INFORMATION �a TT _____ Permit Number SWG 2 0 20 - o U-z o Parcel# 2 o 30 - 7 - i U00 Z Applicant Name ��4«/ ,oq�� Subdivision (Name/Div/Block/Lot) Applicant Address P U, ,So.-,_ 5-s- SA , = 12/z • G4,,-- 2 J City, State, Zip , c/-/:---'4/?!, 1--- yb9 s--;�- Installer Name �,q/7 w0/e,r am Site Address 2 SF z.„.:.:2Gooi/ G-r✓ Designer Name c/,i,<,s -Ees„�Tf yof.'r v6. INSTALLATION CHECKLIST Full System Installation ❑lank(s)Only ❑ Drainfield Only 0 Repair ❑Other System Type /Y.r vti.o Pretreatment Type >5 ft•from foundation? - - ❑N/A 2 YES ❑ No >50 ft.from wells? - .- El DJ >50 ft. from surface water? - - ❑ P ❑ H Cleanout between building and tank? - - 0 I] El Tank baffles present? - - ❑ EQ ❑ a24"access risers over each compartment?- - ❑ 52 ❑ co Effluent filter installed?- -- ❑ ❑ Septic tank capacity p p ty(working) \X.---;` e ' gal Manufacturer O;-:zy/tZ,,,4.;4i ti-D=box-water level and speed levelers used? - - --�-- p ❑ ifA _ __�xEs---- U No O Manifold/D-box aced iss ble'from surface2____V ___�—•-,.-... -•---�- ❑ ❑ QQ Check valves installed? -- w---_----- "y `� '- -Tranport Line Size Schedule/Class - Bedrooms installed (check one) ❑ 2 El 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A IK] YES 0 No 0 >100 ft. from wells?- - ❑ ❑�- 0 -i >100 ft. from surface water?- ❑ Q ❑ W Is >10 ft.from potable water lines?- - ❑ El El Q > 5 ft. from property lines and easements?- - CI l ❑ tx >30 ft.from downgradient curtain/foundation drains?- - ❑ Wi LI CI Drainfield level and observation ports present - - ❑ „ ❑ 0 Graveless chambers or f Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 1I1 El Pump tank setbacks consistent with septic tank?- - 0 N/A E] YES ❑ NO Pump tank capacity(flood) /Zoo gal Manufacturer ��� ,�,,,,�;�-, Z 8 0 CI access riser(s)and accessible from surface? I-- 0.. Alarm or Control Panel installed? - '- ❑ 0 2 Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ 0 D t. Pump installed in E] Bucket or ❑ On Block or ❑ Other Pump Make/Model i.-1 v\Li `�-,? Elf Floats or ❑Transducer a. Tank draw down 3. S� in/min Pumpcapacity e7. gpm g G. p ty Squirt Height 7.D ft Pump on time /.,-/,,,,;� Pump off time 6.6 /4rs Daily flow set at `Igo qpd Updated 821201E . laccail 71 JAN 17 Mason County OSS installation Report pg. 2 Parcel# 2023 ABANDONMENT RECORD 8Y _ Were existing septic components abandoned as part of this project? - - Q YES DATIO If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? - - ❑ YES/✓fi.cl 0 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: Grainfield&manitofd orientation&layout.Septic/pump tank location.North arrow,reserve draarfw,kl.existing and proposed buildings.location at walls,vraterfines, wells,observation ports,cleanouts,and other maintenance arres,s points. Incomplete Record Drawings may arse additional delays in final installation approval and related permits, s2i • lif'�,t"' /.e c /?_0 4>/2.4�.i/A./ 0 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /certify that I installed the system in accordance with /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 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 1 w 3 W#Pi‘ Signature of Installer Date • oy,.n f Pnn ed Name of Signee ;; `�!�;' -0 r:J MASON COUNTY PUBLIC HEALTH ( a$�y�j8 J;E9 The undersigned approves this Installation Report and •4-‘" 6%, Reco rawing on behalf of Mason County Public Af•I <''r H aith: "-z— (Al Z-0----7-- . • Sign ur nvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE arztrzota 1. ..c• '•R'..��„I .. _.gyp.._. .. 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