HomeMy WebLinkAboutSWG2020-00511 - SWG As-Built - 2/17/2023.A.
1
Mason..County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG ZQ ZD-0051/ Parcel # A1004 - 1LI- 90103 - __-_- -
Applicant Name Q(Ct4. Kick 1,,) Subdivision (Name/Div/Block/Lot)
Applicant Address 1 / 7 Ave E
-
City, State, Zip viNWXVQ W 11375 Installer Name ciACbty Qeurl,AN0
Site Address 3t441 E ?tt.k.ertrn RO Designer Name Jttfti L4uMer
INSTALLATION CHECKLIST
[Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type_Gicifs6A Pretreatment Type____
>5 ft. from foundation? - - V/A ❑ Y s ❑ NO
>50 ft. from wells?.• - - - - - • ❑ ❑
Z >50 ft. from surface water? • • ❑ 1 ❑
HCleanout between building and tank? - • ❑ El
U Tank baffles present? - • ❑ ❑
a24' access risers over each compartment? - - ❑ r, ❑
W Effluent filter installed?- • ❑ V ❑
N
Septic tank size gal Manufacturer _
C1 D-box water level and speed levelers used? - - - 'NIA ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- • ❑ li ❑
002 Check valves installed? - • II � ❑
di Q �� IZSZ
Transport Line Size _I" Schedule/Class_y( _
Bedrooms installed (check one) ❑ 2 Ilrf3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - [�N/A ❑,/YES El NO
Ca >100 ft. from wells? - f VET U J!a ■ 4Q LI
W >100 ft. from surface water? - u D
❑
1 >10 ft. from potable water lines?- - FEB- I.6-2023- - 0 0
Z > 5 ft. from property lines and easements?• ❑ ❑
CL > 30 ft. from downgradient curtain/foundation ?ins?` - l4 • [*� ❑ ❑
o
Drainfield level and observation ports present • ❑ V ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over cirainfield?- -• - ❑ Ui ❑
Pump tank setbacks consistant with septic tank? - • ❑ N/A VYES ❑ NO
• Pump tank size 10O06 gal Manufacturer _fifitieriMAU
Z - ❑ �' 0
< 24'• access riserls) and accessible from surface? - - --
F- Alarm or Control Panel Installed? • _- • ❑ V ❑
2 Control Panel equipped with Timer/ ETf
a ❑ 1 ❑
vt /Counter- -
m
d. Pump installed in ❑ Bucket or ❑ On Block or y[} Other_ ota idi&e i ..( to CQ7..
2 Pump Make/Model Iitjeb#xol) IaG✓✓_1EWO.-S!l_-- 0 Floats or Vransducer
R. Tank draw down _ -1 n in•min Pump capacity - to ___gpm Squirt Height fp`___ __ ft
Pump on time progrte my._ Pump off time f elyn Daily flow set at _ 3O __gpd
a
Mason'County OSS Installation Report pg. 2 Parcel rr 22.00C1 r 1 4 -9010 3
ABANDONMENT RECORD - +�
Were existing septic components abandoned as part of this project? - - - - - - [] YEs li NO
If yes, please describe -- -- ----___--�__
Were all components pumped out and properly abandoned per WAC246-272A-0300? EilYES [] NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development '.. +
flra•.vings sont•tm flr•i." elm 3 manifold o•;entation Si layout.SootC'pump tank location,North arrow,reserve drain':eni exist^g and proposed budd'ngs,wcaton of wells,•m:'
:;efts,observation ports,.:IeanouU,e-e:;tner ma•ntenanrxt a.x.•,':. .i r p, Inoompteta Record Drawings may create addlt nnal d•ttrmys:n final instatlaton approval and related; '
56-6-- A.—r-r-.4-cd•tc1/4
(Record 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 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 thin:
form and att, e rd Drawing is accurate. form and attached Record Drawnn( is accor- to
r--- OM/ i 41111111Noi&a.,,1 I
. WA .-:,
�S+gnat re of installer
d1 L t) +t S I -23
s V.
Printed Name of Signee 00',,4';tcomm w�'�•
1.4.‘ .I rill'l'A
MASON COUNTY PUBLIC HEALTH of<4,„ e stl
r h' 51%273 ;>'ea
the undersigned approves this Installation Report and ro p�, IAMBktTtTER �+
Record Drawing on behalf of Mason County Public itcEtisEn bftc.!�cit +f
��......i. �5. -lik 116.41Kw ,
Healtt l MIMES:tS: 03/22/
,70
S gnahue of Environmental Health Specialist Date (stamp. signature and date)
PHIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY IhEB SITE
.
•
a•
•
!l '•
•
i
•
04 l',. f ' / ..ssi :
/ IC) * i ,
4. .
Xi
•
• 4111"111111111111:
•
CF l
g
r
. •
•
! c.,
CI-flil
` r
▪ sr�F, G'y
kr
•n v .4
/ /4 .
N -z x, y�▪ 11�'+
N.J
/
i.
. 1
n
cn
z
j
•
C
pn vN p1 / , [ -rirl -13
,30 •
0 z
pril � X t m
wm Z a W ,1
G7 .N• 0 7 • •' J
D 0 ! ,�
n
• .„
f fc" t. f , '----'-----------------.....
m A sN Z � o I
/
F
,
,/ .
m
tp
i` f f i i 11 _ s)
•
i
1 ti