HomeMy WebLinkAboutSWG2023-00046 - SWG As-Built - 3/13/2023 ..i.C,
.:(...ion County OSS Installation Report pg.
MASON COUNTY PUBLIC HEALTH
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APPLICANT!PERMIT INFORMATION
Permit Number SWG 2.0—
Applicant Name IQ Parcel# l33 -- ZV.• OaOcb
6 r Subdivision (Name/Div/Block/Lot)
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Applicant Address ��es
City, State, Zip (� ey Installer Name 3ib .c�
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Site Address
Designer Name Clod Xly�•
INSTALLATION CHECKUST
tiff Full System Installation 0 Tank s
t 1 Only ❑ Drairrfield Only ❑
System Type �:. `( Repair ❑Other
_ Pretreatment Type
s5 ft. from foundation? -
>50 ft. from wells? ❑N/A YES 0 NO
t r -5t`,ft. tram surface water? - _ _ _ __ _ _ 0 0
i < Cleanout between build k?building and tan _ _ ❑ 0
7_ - t i
V Tank baffles present? _ _-- ---- jl 0 0
Z 24 access risers over each com r �' (' Z��'t j 0 0
Effluent fitter installed?
pa compartment. ` _ - - - 0
E00
Septic tank capacity(working) IZ�p i 0 ❑
By
anufacturer - • • di
S D-box water level and speed levelers used? -
O0 MartifoldfD-box accessible from surface?- N/A ❑ YES 0 NO
InE Check valves installed? - 0 C
h 0 El
Transport Line S:ze VL
ScheduletClass
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It Bedrooms installed(check one) ❑ 2 3 __._.-__�^
Jf >10 ft. from foundation? - ❑ ❑ 5 0° ❑Commercial/Other
o >100 ft.from wells?- 0 N/ANot YES ❑ NO
a >100 ft.from surface water? - 0
ZW 0
>10 ft. from potable water lines?- 0
> 5 ft. from property lines and easements?- 0
( 0
30 ft. from downgradient curtain/foundation drains?- _ ❑ Dyr
Drainfield level and observation ports present Igr ❑-' El4.
lie
Graveless chambers or Cleangravel used? ❑ ig ❑
❑ check one)
Proper cover installed over drainfieki?-
❑ NO0
Pump tank setbacks consistent
with septic tank?-
Pump tank capacity(floor 11 15 0 N!A YES NO
w24"access riser(s)and accessible from surface?_ Manufacturer _ LY. <
0 '
a. Alarm or Control Panel Installed? ❑
Control Panel equipped with Timer ETM I Cour:,er- - - - _- _ 0
( a Pump installer in Bucket or - - 0 n
❑ �Or. BlccK or ❑ Othe
Pump Make;Niodel ' k -----
.. 'LVFioats or 0 Trar s`t,cer
d Tank draw down �� in/min Pump capacity
SO
Pump or. time •2.. Pump off time Daily flow set at
Q__gpd
,raced B;2;-201:i
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Mason County OSS Installation Report pg. 2 Parcel Ff LZI 33—Z`E - or)coo
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ABANDONMENT RECORD
vc:re existing septic componet.ls aoanuoned as part of this project?
INO
�•' yea. Fuse describe -- --- ----- ----- -- � YES
--..!ail components pumped out and properly atandoned per WAC246-272A-0300? — —— a yES -----N
Ej NO
RECORD DRAWING
Ibis ra apbetilattent rtc:ote and meet be srcucate and deserepUre enough to rr.locate in the need of ma ntenanc a activities and future development. Tyocai Record
ntav mqs mow) Otaickak:&manirnkt anental:w'&kit•out.Sep;n:'p.'np tank txation Math arro :eser a Oral n'*Id exIs ng and proposed b NefiS of wva'm Pons.*wows.apt,(lee:maintenance access -,. v eon ppiovn of welts ell waterlines
pWr.:.. 1'�Gu'nokir Recc,v a.ngs^a•. 1eale aeddio.nal aWaya:r.final+tstal:alion aup:ove and rEtibtitll permrs,
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1.10023 avY"
MaR �1E��P�N� I I; �2`� �►��
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XRecord Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
/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 cleafediapproved 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 attach Record Drawing is accurLate__. form and attached Record esf•wing is accurate.
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Signature-otf Installer rr Date %Q
m ire f Y(Asy
i �' 'f zc F'1
•,.tc'a Name of Signee 1 6")4'
04, N4P• 1v/
MASON COUNTY PUBLIC HEALTH �i Viikci,.,r s to F$
he undersigned approves this Installation Report andIr O LICENSEDDESAGNE- /IT
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. t�rd Drawing on behalf of Mason County Public Au�►% �������"� `1,`.�=fir
II EXPIRES os.�tor
(4‘; /14-'
3--i 3----,2_5
.��anatt v mental Health Specialist Date
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VIEB SITE t'tx:,,".1'�2'tole
N.
M —':1 j J J
APPROVER
MAR 132U23
M �I�NT Y EN V1RON
MENTgL HEALTH
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