HomeMy WebLinkAboutSWG2021-00331 - SWG As-Built - 2/22/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG ; \— cx--'‘),'D)\ Parcel# Z2—OV?570002.(Q
Applicant Name Q ivar iJJ r Subdivisi n (Name/Div/Block/Lot)
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Applicant Address - nA �b � 1Su c\--A- ,.c).V \)\\( `"' - 4`
City, State, Zip S h e Iron, IAJF ' / Installer Name ifertA ce Bra fhers
Site Address `�A VYL P . Designer Name On IP ialti'fk,
INSTALLATION CHECKLIST
0 Full System Installation nk(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type Pretreatment Type
>5 ft. from foundation? - -- ,❑�/N/A OYES ❑ NO
>50 ft. from wells? - -' L1� ❑
Z >50 ft. from surface water? - - ❑ ❑
H Cleanout between building and tank? - •- El77 El0 Tank baffles present? • - ❑ / 0
F- 24"access risers over each compartment?- - 0 ✓U, • ❑
W Effluent filter installed?- -- 0 0
cn
Septic tank capacity (working). gal Manufacturer
0 D-box water level and speed levelers used? - - NIA ❑ YES 0 ND
DO
J
Manifold/D-box accessible:from surface?- ❑ 0 '�
002 Check valves installed? - :,T - .0/ 0
/ ❑ ❑
2 Transport Line Size 4 f ` Schedule/Class cl 0 -
Bedrooms installed (check one) u`,'i 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - 0 N/A E YES ❑ NO
O >100 ft.from wells?- - ❑ LI ❑
W >100 ft.from surface water? - -- Ell El
LT >10 ft. from potable water lines?- -- ❑ Pi ❑
Z▪ > 5 ft. from property lines and easements?- - ❑ [V] 0
CL > 30 ft. from downgradient curtain/foundation drains? -
- ❑ 0 ❑
ca
Drainfield level and observation ports present - - 0 0 ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- — ❑ 0
Pump tank setbacks consistent with septic tank? - - 0 N/A Thr YES 0 NO
Pump tank capacity(flood) I D C() gal Manufacturer (4 ,
Z
et 24" access riser(s)and accessible from surface? - - 0 L. 0
1—
EL Alarm or Control Panel Installed? - - 0 a ❑;
2 Control Panel equipped with Timer/ ET /Counter- - ❑ 0 'ti
D
IL Pump installed in ❑ Bucket or On Block or 0 Other
EPump Make/Model �o�� lS 1) IS Floats or 0 Transducer
R. Tank draw down ,` t1•4,4," ,,'`in/min Pump capacity gpm Squirt Height iti A ft
Pump on time b r, i,‘4,,-10-,,,k- Pump off time 1I /r Daily flow set at I i ' gpd
Mason County OSS Installation Report pg. 2 Parcel# ., �Ss1 O� '}
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - YES NO
if yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? ' - YES El 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: Dtaintiehf 8 manifold orientation&layout.Septic/pump tank location.North arrow.reserve drainfield,existing and proposed buildings.location of wells,waterhnas.
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional dArys in final installation approval and related pounds,
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rf—'" r r ,1 Lr fit
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16 �(CL
Si Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
I 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
i further certify that all information 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.
r
Signature of Installer Date
t/Q USA 2/ 6/2 ; `?j
Printed Name of Signeei.` "'s ' i,<,
MASON COUNTY PUBLIC HEALTH •
The undersigned approves this Installation Report and
;H
Record Drawing on behalf of Mason County Public
' r,t L. -, A
Health: t. - S_GNER
(Act,m0)144 Z�Lzl z3
Signature of Environmen at Health Specialist Date (stamp, signature and date)
THIS FORM MAY RP SCANNFr)ANn AVAII ARI P FfR Pt lRI IC:VIFW CAN THE MASON C`Cll INN WPR SITE Updated 8/212018
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