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HomeMy WebLinkAboutSWG2020-00470 - SWG As-Built - 1/27/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG —1-- -e..: - , Parcel # ":;-/c :5',3 ^ e..9 car.., 7- Applicant Name �'gE i) 114 Subdivision (Name/Div/Block/Lot) Applicant Address `�,U, t ( S'fA S!'-/Vil.t.--cvc-g` City, State, Zip MC 14.c >�/k-I fi 11s ° Installer Name f'i/( 04(7-44414,,c Site Address 2i 1 0 E e f/cs7v/Mw A' Designer Name 7-41 /sbv,?.%/r�,2., INSTALLATION CHECKLIST a-Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type k1V JJI Pretreatment Type >5 ft.from foundation? - - ❑ N/A I DYES ❑ NO >50 ft.from wells? - -- ❑ ❑ 0 Z >50 ft.from surface water? - - ❑ [ 1— 0 H Cleanout between building and tank? - - CI [� 0 U Tank baffles present? - - 0 Ci."" ❑ a24" access risers over each compartment?- - ❑ [3o' 0 W Effluent filter installed?- -- ❑ Gr 0 to Septic tank size I gal Manufacturer / /41✓ 011 CI D-box water level and speed levelers used? - --....1--....1dN/A El YES El NO o O Manifold/D-box accessible from surface?- - 0 0 0 c �f :9 Check valves installed? - - 0 0 0 �"' l pQ o C Transport Line Size Schedule/Class o N 1 N Bedrooms installed (check one) ❑ 2 D 3 ❑4 0 5 ❑6 ❑Commercial/Other i i >10 ft. from foundation?- - ❑ N/A El-YES ❑ NO I >100 ft. from wells?- - 0 0 W >100 ft. from surface water? - - 0 [ ' ❑ ti >10 ft.from potable water lines?- - 0 0 Z• > 5 ft.from property lines and easements?- - El Lff ❑ cc > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ ca Drainfield level and observation ports_present - - ❑ 1`'' ❑ ....-- 0 Graveless chambers or Er Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ Et-- ❑ Pump tank setbacks consistant with septic tank? - - 1D-'N/A ❑ YES El NO Y Pump tank size gal Manufacturer Q24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ ~ Alarm or Control Panel Installed? - 0 0 0 a E Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑ ❑ m a Pump installed in ❑ Bucket or 0 On Block or ❑ Other a• Pump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at qpd Updated 8121/2018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES Er.NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ 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: Drainrield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. • • I �.4o� p © tPPA \1 I I , t +` `s k! -ak [a, Si `I- T,/ rG V ❑ Record Drawin• Attached t a CERTIFICATION OF INSTALLATION 7. INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with I certify that the system has been installed in accor- 72 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 I 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. 41 i //1 Signature of Installer Date 14100 64 I L.c. VL't t-Tilt''(74L /•. ,\ij IL Z Printed Name of Signee „ .- w,, �.j MASON COUNTY PUBLIC HEALTH ., 2 1., r/t 5.;:,pc The undersigned approves this Installation Report and ��; 51(Xiz73 Tj Record Drawing on behalf of Mason County Public LAMES R.Iiij. q �� Health: 'ke Crp"F : �r/7_ vlt. S 03,)_2/,Z <(vn I I7 ?Ji�j 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 8,21/20t8 • • • • • • /zs . ....„._•....___ . ,,,,. I --1,. cc____:, • 40 ii :.(..: :--A ti y ` __ __- — i___. -7 S.,, ��11 �J � .., • l • o �' O • ti m � C w a �• • a • • 014,1 • ma/.n. NOmay •1 .` ` N / �y5 %-i Aar. • f . • 1 I. ' ! i i 1 • 4 0 p ' rn v w s 4 • W • m o Ea I • • A D X C 1 G I ' w m Z 9 t U.) I.0 GN �i . � w 7 • i �, . cr i 'i 1 1 i , : • • 111) O