HomeMy WebLinkAboutSWG2022-00472 - SWG As-Built - 3/20/2023 C."c
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
Permit Number SWG '1012--( -)4 i'_ Parcel# 22 0Zc---tcl ^'C0 I
Applicant Name �1 ot,,)1S•'t.` � ti Subdivision (Name/Div/Block/Lot)
Applicant Address 1''kv t.M i Nm1J T DL"T +1c- 10 p- sty/ A-- 3 47 k')O
City, State, Zip S X-1-1* VJA CIV' 1 Installer Name ...--> y+It evo l.b^tire--et(-1Y-3
Site Address t(L)t X" IACiarr Litz Designer Name ' �(..- +P,S. A-�-
.} F
®Full System Installation ❑Tank(s)Only 0 lDrainfleld Only 0 Repair 0 Other System Type 'i\)_ 11�j ?e-c"'� L . Pretreatment Type NI`�ij�
>5 ft.from foundation? - - .sJA ❑YES ❑ No
>50 ft.from wells? - 0 _ 0
>50 ft.from surface water? - ighR�� Z3 _ _ _ - ❑ 2 ❑
Cleanout between building and tank? ---- - ❑ _ 0
Tank baffles present? - - 0 1E7 ❑
24"access rsers over each compartm4t? �`� a 0 - ' 0
Effluent filter installed?• •- ❑ 0
Septic tank capacity(working) t r-•0 .gal Manufacturer 1 a)t='.►.-"•�e4gt,P.--
-5 D-box water level and speed levelers used? - '-+ltl► ❑YES 0 NO
4 Manifold/D-box accessible from surface?- - 0 tR- 0
Check valves installed? • - ❑ -- 0
Transport Line Size 2 Schedule/Class ` C3
Bedrooms installed(check one) 0 2 '` 3 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - .tjiA ❑ YES 0 NO
a .>t 00 ft.from wells?- - 0 bin:- 0
>100 ft.from surface water? - - ❑ - 0
>10 ft.from potable water Nnes? - 0 ❑
- >5 ft.from property lines and easements?- - 0 ?4a' 0
>30 ft.from downgradient curtain/foundation drains? - - - - - - -- - - ❑ --- 0
Drainfield level and observation ports present • - ❑ r ❑
' '0 Graveless chambers or ❑ Clean gravel used? (check one)
' Proper cover installed over drainfieid?• - - ❑ - ❑
Pump tank setbacks consistent with septic tank?- • ❑ N/A TA-YES ❑ NO
t. Pump tank capacity(flood) k.W gal Manufacturer 1 c1>,.t4f-'c'e4.-
.
24"access riser(s)and accessible from surface?-
IN-.. - 0 ee5-- ❑
Alarm or Control Panel installed? - - 0 E.. 0
Control Panel equipped with Timer!ETM/Counter• - 0 1K 0
1)' Pump installed in 0 Bucket or VI,On Block or 0 Other
Pump Make/Model ' ..1 e,E4'-C'y LP_L&) -Floats or ❑ Transducer
i'. t
Tank draw dawn �-�� in/min Pump capacity 42 .5" gpm Squirt Height 5'7 1hk.11Es
lit,. y .
Pump on lime(Wy NJ '`f TSlc- Pump off time 6 f-t-ia-c, Daily flow set at ->W v qpd
•
O itE,V If•-, uoaa.a anions
7, 4 rzi
- - BY:
Mason County OSS Installation Report pg. 2 Parcei# 22oZ-�-�`� - 10�
Were existing septic components abandoned as part of this protect? - ❑ YEsO
If yes, please describe 1
Were all components pumped out and properly abandoned per WAC246-272A-0300? ❑ YES N A ❑ NO
7 "r':'4- i'Cz .!,L.,. r'4 . . ,+ R TECOF.M.- R,AZ�_`7` _ . - .. .
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Tnia Is a petramnaIt record and must be accerria and descriptive enough to re-boats in the need of maintenance activities and tutors development Typical Record
Drawings contain: Orain(Nd&naMoid orientation&layout.Septic/pomp tank location.North arrow,r erve drenheld,existing and propo>.ed bufdnga.location of welle waterlines,
welts.observation ports.deaneuts,and otrer maintenance access points incomplete Record Orrwnps may create addconal deisys in final installeacn approval and related pemuts.
,1ppROVE
:4‘, MAR 2 0 2023
\; -CQt}NTY ENVIRONMENTAL HEALTH
JBW
Record Drawing Attached
INSTALLER DESIGNER!ENGINEER
i certify that I installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped APPROVED'try 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.
.r_. �.�- 3• i 1_a 2-3
Signature of installer Date f,
Printed Name of Signee ?l ' ,ri„1
r c toAT.'ri r i
MASON COUNTY PUBLIC HEALTH :`�'�yy•�7�:far 1
The undersigned approves(his Installation Report and ••' ''/.,_ t t'•-VA. 4
Recoa. •rawing on behalf of Mason County Public ��; 5� '` e3 �rti
4 / r O: RiC R. :IS "_-Li.. .. ,t-
r-,4 W �,tn�� 3-.20 t' �,t-r;,:,c a: it t€rt'
Iit Intl`;' ..., 1 :
Sig•atur-trrnvironmentai Health Specialist Date 1 •
(stamp, signature and date)
4
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uFlated e212°le
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