HomeMy WebLinkAboutSWG2018-00045 - SWG As-Built - 3/20/2023 C. G
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2 O t b - OG) 45 Parcel # 22,12, ?Soo /O Z s.
Applicant Name r4y„u,,.4 7.%vh.< it— Subdivision (Name/Div/Block/Lot)
Applicant Address 14/ 5 Audis/.1 Ave._
City, State, Zip ?.N3,, .b... C, c/10,L Installer Name S>n•,.r i'cg. Co...e4 ,
Site Address 90 E Qrcl,..r./1 bx Pe. Designer Name Z6or+ y55F
INSTALLATION CHECKLIST
'Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other
System Type /6-r ab, Pretreatment Type bs+r Sco A',... toi4the
>5 ft.from foundation? - •- ❑ N/A YES ❑ NO
>50 ft. from wells? - - 0 0
Z >50 ft. from surface water? - - El Z El
< Cleanout between building and tank? - - 0 El
V Tank baffles present? - - 0 ❑
a24" access risers over each compartment?- - ❑ ❑
LLI W Effluent filter installed?- . ❑ 0
Septic tank size $tJ iZ g 60 gal Manufacturer t'/`i.c r.....w1S
D-box water level and speed levelers used? - - ❑ N/A El YES ❑ NO
J
00 Manifold/D-box accessible from surface?- - El 0
u.
mZ Check valves installed? - 0 ❑ ❑
OQ
2 Transport Line Size / " Schedule/Class 4c.)
Bedrooms installed (check one) 8'2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- ❑ N/A YES 0 NO
0 >100 ft.from wells?- - ❑ ❑
W >100 ft.from surface water? - - El
EC >10 ft.from potable water lines?- - ❑ ❑
Z > 5 ft.from property lines and easements?- - 0
CI
> 30 ft.from downgradient curtain/foundation drains? - - 0 0
ci
Drainfield level and observation ports present - - ❑ 0
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 0
Pump tank setbacks consistant with septic tank? - - ❑ N/A EYES ❑ NO
Pump tank size r LSo gal Manufacturer Het/,4.0,44.r•.`i
< 24"access riser(s)and accessible from surface?- - 0 2 ❑
F-0. Alarm or Control Panel Installed? - - ❑ IE. ❑
2 Control Panel equipped with Timer/ETM/Counter- - ❑ ❑
M
a. Pump installed in ((7 Bucket or 0 On Block or ❑ Other
2 Pump Make/Model pi 3oo$ t ! O''¢acv Of Floats or ❑ Transducer
n=. Tank draw down in/min Pump capacity 3° gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel # 22 /2- 7 5 roo /0 2 5
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES 0 NO
If yes, please describe:
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 Typical Record
Drawings contain: Dracrfeld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings.location of wets,waterlines.
wells.observation ports,cleanouts,end other maintenance access points. Incomplete Record Drawings may create additional delays in final Installation approval and related permits.
0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
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"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 I further certify that all information contained on this
form and attac ecord Drawing is accurate. form and attached Record Drawing is accurate.
.j/z./ t
Signature of Installer Date /A
1
c/ i.1• '�`�
Printed Name of Signee ,I� f'�~ Kai:
MASON COUNTY PUBLIC HEALTH IH'1• p , g
The undersigned approves this Installation Report and I/Q,• ROBE 51003 MVsSE
Record Drawing on behalf of Mason County Public ,/1 • L •a "•
Health: EXPIRES
E:1 (-1-\Q-Cr\
Signature of Environ ntal Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/20t8
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JUL 31 2
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atao (6 '\\ MASON COU'TEWhVII-ROJN
1ENjAL hEAL' '
PROPOSED
SHARED DRIVEWAY
A
EXIS . \\ �`
BLD.
A6--,-- % s
SLEEVE WATERLINE WHEN W/IN 10FT
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C' \ \ -/ • 7 7 (1•
\ .ct.• .kr 7 7 �4A
7 id P.'. i Ail
APPROX. .. . ..
DRAIN FI ELD/ BUILDING •• RES
BUILDING LOCATION • Expr
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SETBACK LINE • `\d'=
8 1:)\
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`�7 • MARPRov 2 0 2023
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POSSIBLE TANKS LOCATION. \ MASO�COUNTYE;yyIROhMEhT.gl NEAt.l ,'•
MAINTAIN 50FT FROM
SHORELINE, 5FT TO PROP. RET ,��\-
LINE AND FOUNDATIONS. <� �, � ��
.?' 4j,4"
NO VEHICULAR TRAFFIC ALLOWED ON P,QQ�
DRAINFIELD AREAS.
MAINTAIN 10FT FROM SEPTIC
COMPONENTS TO PROPOSED WATERLINES. •�
PARCEL COMBINATION BETWEEN PARCELS: USE/MLE1
22127-50-01025 & 22127-50-01902
REQUIRED PRIOR TO INSTALLATION.
INSTALLATION DESIGNER SIGNOFF/ASBVILT FEE WILL
BE CHARGED AT TIME OF INSTALLATION
PIONEER DIGGING, INC. CUSTOMER: RAYMOND TURNER SCALE:1'30 1 I
PARCEL# 22127-50-01025 TEST HOLE I SEE OTHER HOLES ON
SEPTIC DESIGNS ADDRFSS: 90 E ORCHARD BEACH 0-26 SI LOAM NEIGHBORING LO1 WITHIN
�p 26+MOTT SG VACINITY OF D4F AREA
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N i Q i pFSS� ROOTS-22
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