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HomeMy WebLinkAboutSWG2015-00403 - SWG As-Built - 3/3/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 24 pi - G D ,) Parcel # -1) O/o 5 I G 04_-> l Applicant Name l)E2i.-' c I ZJ' 1/c - Subdivision (Name/Div/Block/Lot) Applicant Address •y2 `I-0 1-/ 2.t' 4✓vim LA-/Lv' I SA y�"` City, State, Zip SQrY,T L�k`' I bcrd Installer Name t(4 M(-IA ie,i./ki-, Site Address -1` . \'- Or(hilt (41&4 '1 Designer Name vn li N by Ir A-'S5 ' INSTALLATION CHECKLIST [Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair 0 Other System Type .?S44V' ")/ /VK WA-'' Pretreatment Type Nu GJit 7 -i' l'•40---4( >5 ft.from foundation? - - ❑ N/A [1ES ❑ NO >50 ft.from wells? - - ❑ `' 0 Z• >50 ft. from surface water? - - ❑ El HCleanout between building and tank? - - ❑ 9-' ❑ U Tank baffles present? - - ❑ ❑ 1-- 24" access risers over each compartment?- - ❑ ❑ - ❑ a W Effluent filter installed?- - ❑ ❑ Septic tank size I 1 ' /I Z ry gal Manufacturer I e, ' r✓ T, 0 D-box water level and speed levelers used? - - [4N/A ❑ YES ❑ NO �J Ou. Manifold/D-box accessible from surface?- - ❑ Q- ❑ ODZ Check valves installed? - - ❑ l ❑ Q Schedule/Glass E Transport Line Size Bedrooms installed (check one) ❑ 2 0 3 [e4 X5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A DIES ❑ NO >100 ft. from wells?- - ❑ 0'' ❑ Cl -J >100 ft.from surface water? - - ❑______..._�.. ❑ W i LT. >10 ft.from potable water lines?- - 1 V I [1 Ktl ❑ Z > 5 ft.from property lines and easements?- (2 - ` e ❑ fX > 30 ft.from downgradient curtain/foundation drains? - - JUN 2 4 ati ❑ o Drainfield level and observation ports present - - + it ❑ Graveless chambers or lean gravel used? (check one) l Proper cover installed over drainfield?- - ❑` `� 11/0' ❑ Pump tank setbacks consistant with septic tank? - - ❑ NIA [ YES ❑ NO • Pump tank size /Z J Z gal Manufacturer i N ri/f"f`4'h'v Q24" access riser(s)and accessible from surface?- - ❑ a, ❑ 1-- Alarm or Control Panel Installed? - - ❑ ❑-- ❑ a 2 Control Panel equipped wit 1OP Count- - ❑ ❑- ❑ m O. Pump installed in ❑ Bucket or 2 On Block or ❑ Other 2 Pump Make/Model Zc E- II& V ❑'Floats or ❑ Transducer EL Tank draw down in Pump capacity `1v gpm Squirt Height /'''/4- ft EL Pump on time ":4.--20"'", 5 -- Pump off time -? 4?'V 3�r.c, .,P- Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as pail of this pr lect? - - EYES 0 NO If yes, please describe: /O: --I// /:!A ' 1 (I /)1 ''P' Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 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. Typcal Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER 1 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 .• ation contained on this I further certify that all information contained on this form and attached ' •- Drawing is accurate. form and attached Record Drawing is accurate. ,,,7-, .,.1,:,,.. Signature of Installer Date r.• ' '':�, Printed Name of Signee .r ; . MASON COUNTY PUBLIC HEALTH \• • J /V`` ' 5100412 V • The undersigned approves this Installation Report and `�' ADAM J.HUNTER Record Drawing on behalf of Mason County Public - 'c �'t.,N' `s:,;N.'s.-. s% Health: )\1\014(..417) 31 2 Signature of Environinental Health Specialist Date I (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121/2018 © © 0 •1. for s Frm Spy eliF. ) v _� / PROP"TY LINE �� 9B� m \ 0 �( _ tiS `C9 0 e • � 280. TP:3190651�0021 • cn \ - • groom 11 _ Q A _____,27 i___.1_16%),00. ' y i _gini__. Aim ,,di ___._.,e, Ox II f!) O --1 Q. 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