Loading...
HomeMy WebLinkAboutSWG2022-00174 - SWG As-Built - 3/24/2023 r Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 7.D•22 - 00)1 Li Parcel # 422-0(451 COO(o°i Applicant Name l ,n,.f-,,, Ci,,,vt-elc-c4li'^f Subdivision (Name/Div/Block/Lot) Applicant Address ri_c) .Y �,,. ;%,-g 9ci City, State, Zip ,c1•44_1 / i.'',. Installer Name (,r,r/rwk;,,, (; ,1 •-‹ 4.4 y Site Address 26 Ix) t-",,,,,,,, 1-1,„,,,„a a. Designer Name Ui�Ar INSTALLATION CHECKLIST ❑ Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type (.7•tt c:,,'iI) Pretreatment Type >5 ft. from foundation? - - - ❑ NIA usi YES ❑ NO >50 ft.from wells? E- i-� t1 - - - ❑ NI ❑ Z >50 ft. from surface water? - I I - ❑ ❑ - - -2.023- -II -- ❑ � Cleanout between building and tank? �}�-�� �] ❑ U Tank baffles present? - -\ - - ❑ � ❑ d24" access risers over each compartme•tEiy--- 1 -- ❑ 2 ❑ W Effluent filter installed?- - ❑ ❑ co rI Septic tank capacity (working) 1 S� gal Manufacturer L14✓t o D-box water level and speed levelers used? - - E N/A ❑ YES ❑ NO QO Manifold/D-box accessible from surface?- - Ni El El uL ca Z Check valves installed? - - 0 ❑ ❑ 0< 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - D N/A ❑ YES ❑ NO >100 ft. from wells?- - Q ❑ ❑ Ci w >100 ft. from surface water? - - © ❑ ❑ >10 ft. from potable water lines?- - 11 ❑ ❑ z > 5 ft. from property lines and easements?- - 7 ❑ ❑ Q C > 30 ft. from downgradient curtain/foundation drains?- - ® ❑ ❑ a Drainfield level and observation ports present - - til ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ® ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tall capacity (flood) gal Manufacturer Z ❑ ❑ ❑ < 24" access rise nd accessible from surface? ~ Alarm or Control Panel In ? a. • Control Panel equipped with Timer Counte - - - ❑ ❑ ❑ d Pump installed in +eke or On Block Other °- Pump Make/Model Floats or ❑ Transducer 2 d Tank draw down in/min Pump capacity gpm eight ft Pump on time Pump off time Daily flow set at gpd Updated 8i21/201 B Mason County OSS Installation Report pg. 2 Parcel# Z Zv ;o ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES E NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 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: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines. wells,observation ports,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 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 1 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. c_thae lac S1 ature of Installer Date �r 1 •e lti rrr(r wele.. Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: `'"7 Y y t 7I2'i IZ 3 Signature of Environ�Healfh Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 RECORD DRAWING (continued) I _-___rt_ 1 � i \ I 1 r 1 . r/ 1 / '6 f' // l / j \ / / �� // A /\ /, / Ak , , , , , APPROVED ' / C MAR 24 202 3 �� c MASON COUNTY ENVIRONMENTAL HEALTIh I `/ RET i 1 / \I r ' , jca 1-\-6,w,v•a C-r, I"; 26,