HomeMy WebLinkAboutSWG2021-00540 - SWG As-Built - 2/21/2023 q MASON COUNT` PUBLIC iiw '- ''
N tiwn Report pg. 1
,.i,ason County OSS installs
APPL.ICANTI PERMIT INFORMATION'
y(� Parcel#
Permit Number SWG a
�- • UAW t A\.Subdivision (Name!Div1Blocaot)
Applicant Name O
Applicant Address t �� v
�
City, State,Zip ,C�. ` 'US; (1 Installer Name
Site Address c-Crl U\.
OS f C S)) Designer Name
- INSTALLATION CHECKLIST I
;Full System Installation 0 Tank(s)Only 0 Drainfield Only 0 Repair ❑Other
System Type Pretreatment Type
~ >5 ft.from foundation? _ n -`----"--- El N/A YES ❑ NO
>50 ft.from wells? - 1 1 . -11-i ,- -- 0 ❑
Z >50 ft. from surface water? - *-- Dr-1
�/ 0
F Cleanout between building and tank? --. FEB 1 7 10"l3 N 0
V Tank baffles present? ie. 0 LK, 0
I— 24"access risers over each compartmer1 -- 0 L__ 0
O.
W Effluent filter installed?- -• 0 0
co
Septic tank capacity (working) 126C* gal Manufacturer 1- .SL &eel/lac-5"
0 D-box water level and speed levelers used? - - Ii tl/A 0 YES ❑ NO
XO Manifold/D-box accessible from surface?- - ❑ [E El
m- Check valves installed? - - Nr 0
04 %` 410
2 Transport Line Size J.. Schedule/Class
Bedrooms installed (check one) 0 2 0 3 V4 ❑ 5 0 6 ❑Commercial/Other
>10 ft.from foundation? - - 0 N/A Cit4ES ❑ NO
CI >100 ft. from wells? - ❑ Fil" ❑❑
W >100 ft. from surface water? - •- El
ti >10 ft. from potable water lines?- -- ❑ Lki 0
ZQ > 5 ft. from property lines and easements?- - ElCY. 0
li > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0
0
Drainfield level and observation ports present ❑ r.5v 0
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 1.1.1 ❑
Pump tank setbacks consistent with septic tank? - ❑ N/A 171 YES 0 NO
Pump tank capacity (flood) 1?00 gal Manufacturer
H24"access riser(s)and accessible from surface?- - 0 Dit/ 0
a. Alarm or Control Panel Installed? - - 0 EV. 0
2 Control Panel equipped with Timer/ETM/Counter- 0 air 0
D
a Pump installed in ❑ Bucket or Block or 0 Other
a Pump Make/Model 1D ,ik? rp e.�, oats or ❑ Transducer
a Tank draw down
min Pump captC�' 1 gpm 1 aSquirt Height " ft
Pump on time 2 c5ez, Pump off time 3 y i!., a S Sc�Daily flow set at gpd t
Parcel# _�i� �� r
Jason County OSS installation aian Report p9DpRMENT RECORD s 0 NO
ABANDONMENT _ _ __ _ - - - ❑ YE
Were existing septic components abandoned as part of this pro}act? - ' " " r - - - -
CIIf yes, please describe' er WAC246-272A-0300? ' " "
YES ❑ NO
Were aft compooents pumped out and properly abandoned Q
RECORD DRAWING
activities and future development. Typical gecord
to re-locate in the need of maintenance future
de a opine or gyp,alw Rene d
This Is s permanent record and must ! accurate and descriptive enoughaim
aK, um tank location.Meath arrow.roserve dramfteid,extttng and rnpro9�final slaYation approval and related U
s.
Dr wigs torts n ports.tield n manifold. of mainauon maintenance
Sept pp. . file Record Drawings may create addibonal delays
Is.oyaervaticm rxxta•cleanouts,and other maintenance access paints. Inaxnpl
PPROVE
D
i': FEB 2 1 2023
9
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
n Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
l certify that!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 Record Drawing is accurate. form and attached Record Drawing is accurate.
sam /03 /�ti.il
Signs re of Installer Date 2'11
`.. '..e,
f it ASP 9I, r
`.. nr MA„,, �, r
Printed Name of Signee i-
MASON COUNTY PUBUC HEALTH `A t'i°,''' •�`%
i r:n;;cTH i !rC)nSF
The undersigned approves this Installation Report and 1 u`R'fJ.Cli tS( "(.Nt
IRecord Drawing on behalf of Mason County Public I """c s .i 1.2 Z-
HealtJJ Y
C �( —ZT3
Signatu ootitiALA61_
nmenta/Health Specialist Date (stamp, signature and date)
THIS FORM MAY RF S1 ANNFr)AM')AVAII ARI F FOR PI IRI in VIFW ON THE MASON COUNTY WFR SITF Updated 8/21/2018
1.--'rHOUSE
BROTHERS
a'TF" Pkt!"Pilk'.AT113N
3604954156
I
The air pump box has been sealed as of 2/15/23 at 501 W Oak
Meadows, Mccleary. Parcel #51935-43-00040
As requested by Mason County
iippROVE
I mi FEB 21 2023
MASON COUNTY ENVIRONMENTAL HEALTH
LBW
I
Business n me: c,a
(
Name: 4 )
/ I
324 t, _4 ,, 'c n C�
.12 r , 00cD
.. r.
,',ov yp' lk '—' d C/a o— C r a
�3 °i W h-+ . C)Ph) • - . z rY CDCD CD , .
•
k w _
µ^. W v)
stesio p 0.• t� (A " a _ o v)
,S .'•. st .p ' :'? O
eP W W 0 I-0 .� Z .� - Z A.UR ,j
'�� slo es OO COIt
c Ora p o OOg Q. CD
PO 4
aO O Cd Q O N. ONO A- ~ . TG ZNe) .
O 5 ' 0 0CD o CD w
O� 0, 4 " = w O fJq c�• A: ►r�
VI Vi n N 0 01 CA O CD " � O
00 n� W O C!, H O -
N cO
� O Q O z.
it
I
� � � P.,) '--
w v7 !.. t]. �D
T 00 = 0
AI
sr.- _•� J O 0C/a cr
-1 R
r f _
1.-.— I w p "cA 0
7 It
\ cs ate.,• 7• r- 0 -. Cl) CD
l� t'^!' '71 y i N co < .*may '
F:- 324.4,8' � _ �' —�
...... ,m \ •.� ' CS CILf.�Y`Y:F_5� '4"s MAPI 4 131,WA`,.`itAl'ZlY.+k�fl•yF TARM'
1- T_
X1.610do.1d o1,CeMan!ap lanea W Oak Meadows Rd
I,\h.
j-: :,5'i - '
T %.
— — —
A\ .......:!•;•.--t.,.....,',-1. • • i......4).1........— .
ak> S� �, 0^ �. o OO •
2A1aSys>z 'ZI +++ 0 0 0RI
o—
o 3 � �_
cn d� � no o—
o v. ---1•
mLIP o
-< o °L. o
CC <53
1 3w
` z N. v- 1 --
C 1 --- C
z 5' -- v
_ � Z / \ N
v gli C:11
Z =_
r j° Hoff to ditch
roof ru c
5• o �div� /
CD
/
Q ..rZ 0 SZ,___LI_ 4\ .-i ?3>-. L'i LA \1 •3
() oP ' V
/Q • o r ^I l 1 \
•
o. o N cc -
• 8 I.-..LT. a> g c., ,
n ti Ti 0 o / rn % Io 'p
=° n � �iO OQ cp
Ic
•
Li--IN = I . ..
=-1---'-lb..../ 0 ----‹*:''''"". . •-1'- —E"-e =
`° N oco 5 �- n
/ N t< o �'` •\\6c� C .--, \8) '-t
fig n Q'
luouaasua peon,0£ 1 CD G
\ �o n d
<
Ite a— • • N /
au►l,Cuado.ld \ 'prop. line _ fen%
z
o z l7 S ,Ar -, ,4.N.�,Vi 4: 4 , AO
Jai �
x
s; 1 ...9 01
V
m •� 48$
rn I" # -1---at�+ Z zi
o cn �.. 1•'--� i R1
v CJ1 •
1--' o H
O 00 ' O T o ', -
' m
•
el
; J pp
M 11Id 23
11111 O m •
f m C O
i a nig 1
4A
co
COL
ul o --,0 .,..: 4, m 4 I .;
Ci) 0x III ., `` 'A —i 212,4
♦.
. ZCRG•1{
v.j•,f Y.,e
` mo,
gab :. .
a.o ti \ ',.
•
UM
MIMI
r Fny ' •• •• • .Y• 111 fi1..
•.
N ~ •`• '
T' •A 1
• I M•
cn Cl)
II Mt
T A 4 •• w••'h• ,i 1
? o z • ,.4 :, r, ,1 n O
CA .:,".,; eft:.•.' 1, 4t.:1,ilk 0 0
V r •� •• ` •.i•
•� 0 . Y I . O
Q •,...,: N;,'..: 0 v' : . Q I M sv O
.�,• �.�•.. O mc
t I r:', 'jam`
r
rn 1 I• .A 1 I 3 A
1 2 I .4, N
xi \1.4•. 4 a; 0
•a. ;• 1- ���ud_.�Y!♦ ......................... i /���••
N a
..g A a .< 1 • ., _ of I� •M
III
er
-! •• \+ �r s= g i Di
.,
•
Pr v
CO Z
Z z
\/ <'',
A Iv
D -V ',',r f• t Vl
31120
o
.....:" ', 5 \"'Ill ------ =)
I.
CC/ •A •
?•t•rJ / f•'•
m v�/ ,
/IIII
Z N /:.. • A �,f 0 # 0
cz z ``' C �• ref /' edik /I� o-1 m • a
En
ii
L-4- CP
. co '1! ' I
�F. �. I ''‘'‘‘ k P3 '. '10 Cr
Vik
�� $Ir k< CD
gel
rrc'�v _
y
y
/ Q.• —
o *0 II til .. N
v)