Loading...
HomeMy WebLinkAboutSWG2019-00215 - SWG As-Built - 2/21/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2c /9 - ao z, Parcel# L/z-Go z. '-.4 G,\003 G q Applicant Name S- A✓ /1/i2 a y Subdivision (Name/Div/Block/Lot) -< 0 Applicant Address s/ii Svr✓/zi.iL /3cx RD. 4,1d /jam /`/-/7 4-r rr c- City, State, Zip ' ,may=/A. �r ?�-5-7.9- Installer Name s. Site Address /6o A-,- 4ie_sr- / O cr. Designer Name CAIX/s c- -o-rr `" INSTALLATION CHECKLIST �� dull System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type PRE SSc//zc ak-...o Pretreatment Type >5 ft.from foundation? - - ❑ NIA Es ❑ NO • >50 ft.from wells? - ❑ 0/ El Y >50 ft.from surface water? - - ❑ L�,� El Z - El Cleanout between building and tank? ❑ ❑ V Tank baffles present? - ❑ kUllri�,/ P 24"access risers over each compartment?- - IDLrd 0 a. W Effluent filter installed? •- ❑9 [ C�S 120 0Wal Manufacturer Q e /�4 f� Septic tank capacity(working) Q e D-box water level and speed levelers used? 0 NIA -ems NO O u_ anifold/D-box accessible from s-u tfa e?-- ----- --._ -=--❑-- ❑ 0 co Check valves installed? - ---r"` ---~TEa 13 Q 6 Q --- --- Schedule/Class 2 Transport Line Size ' Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ommercial/Other >10 ft.from foundation?- ❑ NIA ❑iS ❑ NO >100 ft_ from wells? ❑ • >10 0 ft.from surface water? El ' El LL >10 ft.from potable water lines?- ❑ 1�� Z > 5 ft.from property lines and easements?- - ❑ C] ❑ Q ❑ cc > 30 ft_from downgradient curtain/foundation drains? [jr' ❑ ' 0 Drainfield level and observation ports present - - ❑ E 0 Graveless chambers or attean gravel used? (check one) Proper cover installed over drainfield?- - ❑ g ❑ ❑ Pump tank setbacks consistent with septic tank?- - El kta 1Es ❑ NO • Pump tank capacity (flood) i 000 gal Manufacturer Nagefnco pre CAS t 2 ID LZ ❑ Q 24"access riser(s)and accessible from surface? - ❑ El~ Alarm or Control Panel Installed? - a. - ❑ El • Control Panel equipped with Timer/ETM/Counter- a- Pump installed in ❑ Bucket or On Block or ❑ Other a. Pump Make/Model 5 P U U , Floats or El Transducer M 2., m S uirt Het ht 2- 1✓ ft a Tank draw down .2 in/min Pump capacity gP q g Pump on time / 8' m% sN Pump off time Ars Daily flow set at 5 P gpd Updated 8/212018 Mason County OSS Installation Report pg. 2 Parce{# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES EI- NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES A/A1- ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance...birdies and future development TYPE Record Drawings contain Drainfield 8 manifold orientation&layout,Sep+idp"mp tank location.North arrow,reserve drainfeid.existing and proposed 6rildv'gs,locabm aC we's,water nes, welts,observation ports,n9eanants,and other maintenance ac7wes points. Incomplete Record Di,wring-,maY aeale add"jnal delays tri*mat r appereai and related permits. �7;--77G.r-i > /P2e-io,zr' l>/-z-,7.../,,/ ROVE MASON COUNTYB z �Jew20Z3 ENVIRONMENTAL HEALTH 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 this form and attached Rec rd Drawing is accurate. form and attached Record Drawing is accurate_ Signature of Installer Date Y' r 5C0+4- cl-ohfiSon Aea tk 7i,k s 44 Printed Name of Signee • 4 0 Gn' ac-.. MASON COUNTY PUBLIC HEALTH 285©80 `ate' The undersigned approves this Installation Report and '. •E`nj '6'e a E�� e Record Drawing on behalf of Mason County Public2_;.(-23 �- '•`5'INA 7iiv: iii,„ , .... , c... ?_... , 1---r / vironmental Health Specialist Date ' • (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 821/2°18 0 - . OPOP% CZ 0 co 0 tisl as Z ,�• C.: d Z Z t x 2 \i \, „,.. ,40.- . �° R. m �t . 6, oc�ivG Ak-r.A ° !L� w w zio /SEE'1!'9'0 z • 4 rri • 9L... ,...-..-11—. . 1.: .—7 z— — —'sni r. V O N 3 ?0 IvN " aF ` . Z45 ' ' ; . - .1 t 1 ; ./..------ aO x s 61, •)` f NI kv I h y c ,s„, Fri • ' . ) .. L _____ ______ , ,01 D --:. (I (`� * : .. 0 • !N,,, x /Go�G� -owit/G .'9.CEN � N NRt . o „ 11' ill: , .-. .. - 0 ,.,, 41, 4.- . .. (7.777- -- 0 Q fFl 1n�" �7 O. 's' . 0 VC) (1‘:\ 't. Nt I ,� r— — • 0 ti) . . ; 1c . ! f� : • § Ai" ter` o /� x co ' GRoc../.v AA-G 1 z • •L) :.• .____, W N MP �. . , . o CIO 4ro' 3 .o --i 306% 2-7 C a I n � � I I . � � r owl , ` I I ��� F Way r +rG C , �Z`I / ? Ag T 4\1 II, t n ;',' i.', 0 :'‘T. ; '4,, :I' c, -,-; 0 .,, • lG' 1 TOVh 1D gK �O ZK ! 5 • el • a . c. 14' 3 4 g2 9 roi n�Aa m ,