HomeMy WebLinkAboutSWG2022-00311 - SWG As-Built - 3/20/2023 (3) C- C
Mason County OSS Instal
lation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Parcel # i 2- � 2 `� � � \'
Permit Number SWG 0 ZZ- Uu `Applicant Name In Subdivision (Name/Div/Block/Lot)
�
�_�11 . :.. --
Applicant Address tl 5 C �' aQ-.
1t! Installer Name
City, State, Zip A., .,,,O. i . . ..':
•
Site Address
L.• O i Designer Name
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only 0 Drainfield Only
[]Repair 0 Other
Pretreatment Type
System Type L
>5 ft. from foundation? • -- - -- -f, 1M WA 0 YES Q NO
0 0
4,v _ 0
>50 ft.from wells? - - - - - - c
Z >50 ft.from surface water? - L`'' . 0 0
4 Cleanout between building and tank? -- c +_ -- - - 0 2___/ ❑
~ 0
V Tank baffles present? - -
a24" access risers over each compartment?• - - - - - 0 ❑
N Effluent filter installed? a v, D
ra Cj gas Manufacturer
Septic tank capacity(working) - �wA 0 YES 0 NO
a D-box water level and speed levelers used? 0 Et---- 0
a0 Manifold/0-box accessible from surface?-u.
0
Check valves installed?
0< I n Schedule/Class �C
� Transport Line Size
0 4 CI5 ❑6 ❑GommerciaVather
Bedrooms installed(check one) 0 2 ®3 N/A � YES 0 NO
>10 ft. from foundation? - _ 0 �/ 0
>100 ft.from wells?- 0 0
W >100 ft.from surface water? - .- 0 �' 0
>10 ft.from potable water lines?- - ❑, CJ
Z > 5 ft.from property lines and easements?- - ur. 0 ❑
a > 30 ft.from downgradient curtain/foundation drains? - 0
D Drainfield level and observation ports present
0 Graveless chambers or ❑ Clean gravel used? (check one) ❑
Proper cover installed over drainfield?
Pump tank setbacks consistent with septic tank? - - ❑ N/A
/ YES 0 NO
(flood) �ZSt3 ga -----------'
Y Pump tank capacity l Manufacturer 0056 I 0
< 24" access riser(s)and accessible from surface?- • 0t i ❑
O~. Alarm or Control Panel Installed? 0
2 Control Panel equipped with Timer I ET /Counter-
a- Pump installed in 0 Bucket or On Block or ❑ Other
❑Floats or ransducer
A. Pump Make/Model �( ft
5 pm Squirt Height
Tank draw down inlmin Pump capacity -) b
a. °: � Daily flow set at�--,.,_,,,,_..�t�
Pump on time � ��� �. PU '•��"+�&� _ .. ,
Kbrq[ r 446 Or' Awotla au m ac
Mason County OSS Installation Report Parcel#ABANDONMENT RECORD
_ __ - - 0 YES ❑ NO
Were existing septic components abandoned as part of this project? - - - - - - - - - -
please describe: ❑ Yes ❑ No
If yes, p abandoned per WAC246-272A-0340? ' - - - - ` -
Were all components pumped out and property
RECORD DRAWING Record
In the need of maintenance activities and future development. Typical ib
ve enough to relocate uture de location of wells. al Recoil
Or is a permanent record and must be accurate and descriptive tank location.North arrow.reserve drainfie{d,existing and profiposed nal install' ati n approval and related eranee.
old orientation 8 layout.Septir�pu D create additional delays in
wells. a ahO Ora slated n Uts.and points. Incomplete Record Drawings may
wvNs,ubservaGon ems.�anouts. other maintenanx access
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0 Record Ilk, ing Attached
CERTIFICATION OF INSTALLATION
DESIGNER/ENGINEER
INSTALLER
in accor-
1 certify that I installed the system in accordance with I certify dance with iheesept c design stamped system has been ,APPROVED"by
the septic design stamped"APPROVED by Mason
CountyPublic Health and that any deviations shown Mason County Public Health and that ny deviations
by
11
here have been cleared/approved by both the designer shown here have been cleared/approved'c Health and meet all
and M: _on County Public Health and meet all State myself and Mason County
in Cou ty Codes. State and Mason County Codes
and 1 further certify that all information contained on this
I furtertify t t all information contained on this form and attached Record Drawing!s accurate.
for attach: Record Drawing is ace ra e.
nature •finalSig " Date ,,�•'�•j` .A 4 4o7...3
' e of S nee `,' ' k• '
Printed Na i9 .:z. i•4' , �`
MASON COUNTY PUBLIC HEALTH •:4 (4�,+ '��
approves this Installation Report and r.,rA HUNTER �'
The undersigned �
Record Drawing on behalf of Mason County Public .J;S .SS rs_ cam,' z- .
L a1'.;o:s U,••1a L.�
Health: � .
�-Z o 23
(stamp signature and date)
Signatu or IP!()Mental Health Specialist i . .
R ARP Updait481"18
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RECORD DRAWING continued
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