Loading...
HomeMy WebLinkAboutSWG2020-00420 - SWG As-Built - 1/20/2023 (2) (1, JAN 1 7 2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PL t�i TY JC HEALTH APPLICANT/PERMIT INFORMATION _�__` Permit Number SWG 20 —Go`1 .-o Parcel# y2 o 30 - z 3 —9 vGd Z.- Applicant Name 7-7e4c..y ,9,g-z-/-)„c2 Subdivision (Name/Div/Block/Lot) Applicant Address ,a, .ea< ,s-S--s SP ' /3/3 �• G� 2 City, State, Zip y/l c �/�4R.7, w.4 78 cs - Installer Name T;4m,c wc,2 A,, 2,,,,, Site Address 2. SF r�+Goo i 4,11 Designer Name c,.',<,J •Ce-s T 4O>.i•,•16 INSTALLATION CHECKLIST V�ull System installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type /Y1r04.iv,o Pretreatment Type >5 ft.from foundation? - - ❑NIA Z Yes ❑ No >50 ft.from wells? - -- ❑ ❑ Z >50 ft.from surface water? - ElID HCleanout between building and tank? - - 0 1I ❑ U Tank baffles present? - - 0 ❑ E- 24"access risers over each compartment?- ❑ 01 0 a. 5� N Effluent filter installed?- .- ❑ igi El Septic tank capacity(working) ke-" `- qal Manufacturer t, 9;��,Y;: ��`D box-water level and speed levelers used? ❑ IA YES— ® Manifold]DOu. -box accessible ble rf o`m-surf . - - ❑ ❑ m E Check valves installed? -- �-_--,-------- ----------------______ID--- ❑ ❑ --- Tta`nsportt Line Size Schedule/Class ___ _ -- Bedrooms installed (check one) ❑ 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A 5g YES 0 NO ® >100 ft.from wells?- - ❑ d ❑ W >100 ft. from surface water?- - ❑ 12 ❑ >10 ft.from potable water lines?. - ❑ lin ❑ a >5 ft.from property lines and easements?- - 0 [1 0 re >30 ft.from downgradient curtain/foundation drains?- - ❑ (71 ❑ Drainfield level and observation ports present - - 0 I1 ❑ ❑ Graveless chambers or 51 Clean gravel used? (check one) Proper cover installed over dra'nfield?- - 0 Q ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ril YES ❑ NO Pump tank capacity(flood) /20o gal Manufacturer 4-{A;N .,,% ID • access riser(s)and accessible from surface?- - , 0, Alarm or Control Panel Installed? - •- ❑ Ll ❑ E Control Panel equipped with Timer/ETM/Counter- - 0 111 0 D EL Pump installed in rg�7Bucket or 0 On Block or ❑ Other 1 Pump Make/Model L-.v\Lc '2 rn Floats or ❑Transducer a Tank draw down 3. 5-- in/min Pump capacity e7.s•� gpm Squirt Height o ft Pump on time /.,/,,,,;� , Pump off time 6.o Ars Daily flow set at `1B,o qpd Updated 8/21/201E . JA N 1 7 D Mason County OSS Installation Report pg. 2 Parcel 2023 ABANDONMENT RECORD 8Y:,_ Were existing septic components abandoned as part of this project? - - ❑ YES AO If yes, please describe:_ Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ,4 ❑ 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: Drainfield&manifold orientation&layout.Septiclpurnp tank location.North arrow,reserve dranfekl,exising and proposed buildings,locator of weirs,wale rtin s, wells,observation polls,cleanouls,and other maintenance access points. Incomplete Record Drawings may date additional delays in final installation approval a rd related permits. ST et; 77%�f�Gl/.y,e RE:co RJ !>iZ.i-,.,ift/6 ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that 1 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. NilitAZ k.,),..,...tt.------ 1 /i 0/2(-)i 3 EB!,,e- t‘ Signature of Installer Date ' • '<..4`;,',, ,),.imici, t., -. .......A.ck.ek if.,, ,T:'._, ---zik-.1. , Prin`t-ed Name of Sign /',• .; MASON COUNTY PUBLIC HEALTH 26508 41.4 The undersigned approves this Installation Report and • ..Site-�•�O"~ Reco rawing on behalf of Mason County Public N I' f Y' Ht;'afth: `! 7 Z/ 2._. ------- ./ /---()—;2--) Sign ur nvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE tiPd3led 8212018 K 2 9'7-oo " . /4 G-• "ss S tv • o U7 lL h, j-s/7,1T_ • 1. a. i --------. /' ) 1 . ,..,4 , . ,:, 1fl. 1 ' ) / z �" 0 �'i. ti 0 0 I rilr Mril y a r X o VI ,vi / / z. .. O z _ "I, o L V / N a o\ Q N. o � RI • .o o ieb 75\ r. CI - rn• c I N. • d Ai • . ,.. • 4 ,c\ Cf.) C4 _, ,,, N, :-Ti ,.,„,I,,,t,,,, 4,..,, \I. kl r •.:-..) 0 � 1\/ 0 / r tn. o ti 7,--, / / , 4kt I Z /........, c.,% ' / -41111) I Cl) n D r : a;:, II N i 4 \, 1 k i ° t t h H •r xF BR/GH cl v Z n o r r t,. M rI O v v d M ifv ���?7 �, �`Ip'" 4Z r "a LA x r - In IA a 3 z0 t ly 1` girl -• f m _n n a •a: n { j ra c T�1rmi cn - n ( '• \ n �` v r 1 Mir n 0 Z4 n a w ,41 m (� il o ® 4\ 0Y 1.3 --I R3W LAGOON LN <4 1 N o> r" p . H a n $ © a 8 ZR2W � N • \� gf z m ^c• a n e ci ci ' STEPHENS ( a IN , wzo zz 03 = r dd , S Z Z • nt �< \` McfAMB WAY `} � 1� 11 N m ry 1\ < VX V