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HomeMy WebLinkAboutSWG2019-00403 - SWG As-Built - 3/3/2023 CiG . Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 1/D f�i _ D t? t;° _>, Parcel # lap/n-- f• , Di 4 t Applicant Name DE.72-L= 6,lam - I n/r- Subdivision (Name/Div/Block/Lot) Applicant Address •�1-I-P A-/ 7-Y -V LA-/Lz I 5r e2Lf LK.- City, State, Zip .5 prri i A k I b4tia Installer Name 1-: i GI M t-T l';i'l-44-1 Site Address '4,P w 00 fi iM AV14 12-el Designer Name 4Ti w\ ‘Av p{-N t_. ?. INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other ��� System Type '/1 V t.�/ /vk. V)1 'C�' Pretreatment Type Jac WA-77S .l' 0`--b03 >5 ft.from foundation? - - ❑ NIA EKES ❑ NO >50 ft.from wells? - -- ❑ (r ❑ Z • >50 ft.from surface water? - - ❑ ID" ❑ a. Q :Cleanout between-building and tank? - - ❑ [�{� ' ID:H ° V Tank baffles present? - - ❑ Er ❑ :• 24"access risers over each compartment?- - ❑ Q`'' ❑ a :. W.' Effluent filter installed?- •- ❑ ❑ N : Septic tank size I Stf-P 1 -e' gal Manufacturer I u E=r l-rv'47 01, ® D-box water level and speed levelers used? - - [i/A ❑YES ❑ NO , �� Manifold/D-box accessible from surface?- - ❑ Er" �° 0 �� icemZ.. Check valves installed? - - ❑ E ❑ ' g Transport Line Size if. Schedule/GFass ^` Bedrooms installed (check one) 0 2 0 3 get X5 ❑6 0 Commercial/Other >10 ft. from foundation? - ❑ N/A [� rES ❑ NO G >100 ft.from wells? ❑ [�^ ❑ W >100 ft.from surface water? - - ❑ _ °1----- ❑ {i. >10 ft. from potable water lines?- - ,�. 17 ( t• 'd IL! q i ❑ 2 >5 ft.from property lines and easements? I ti t' `� C ! 0 lil .:.a > 30 ft.from downgradient curtain/foundation drains? - - JUN 2: 4 Er2 Ii .: • Drainfield level and observation ports present - gip' ❑ ❑ Graveless chambers or [Clean gravel used? (check one) I Proper cover installed over drainfield?- - ❑-._--- - ❑ r... •Pump tank setbacks consistant with septic tank?- - ❑ N/A OYES ❑ NO .,YY Pump tank size /Z�4' gal Manufacturer //i n f f rit-1 < 24"access riser(s)and accessible from surface?- - ❑ a ❑ • H Alarm or Control Panel Installed9 n. - ❑ Cam' ❑ 2 Control Panel equipped wit Tim • r Count - ❑` ❑ M . Pump installed in ❑ Bucket or [✓�On Block or ❑ Other ' d Pump Make/Model Z. er.,r E/,:-, (--�• L `Floats or ❑ Transducer d Tank draw down 3 in/min Pump capacity (6 gpm Squirt Height �/ ft Pump on time '"-- 54:-•4 _ Pumpp off time •wM: /Pl f) 31 f e-4- Daily flow set at '3 !_ () qpd • Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as paq of this project? - - ` YES El NO er �''l ..s./ / 4)V t,,. -- ::.. If yes, please describe: l�� �//�� �i�2 9 .� Were all components pumped out and properly abandoned per WAC246-272A-0300? - - p YES El 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: Dralnfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. [f Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 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 1 further certify that all a mation contained on this I further certify that all information contained on this form and attached '- .rd Drawing is accurate. form and attached Record Drawing is accurate. ,gi I A,....,', pwr S7-ISignature of Installer Date • W � �kp'-1, Printed Name of Signee e , MASON COUNTY PUBLIC HEALTH k:g' .fr tP, 6:' 5100412 • The undersigned approves this Installation Report and L>'' ADAM J.HUNTER •: Record Drawing on behalf of Mason County Public - `,.s s_. Health: 3/30- 7) Signature of EnvironFnental 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 8/21/2018 1 © 0 O , © • .,; IIIY as , m DSO. 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