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HomeMy WebLinkAboutSWG2022-00618 - SWG As-Built - 3/16/2023 Mason County OSS installation Report pg. 1 C . C MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG a Oa,le Parcel # p�, 1 0369 /00r Applicant Name A-Ai w ElsK'opF Subdivision (Name/Div/Block/Lot) Applicant Address City, State, Zip sl i.1,t/ 1.444- c3;cy Installer Name A 4c ,+/ 64-i ten h Site Address Designer Name 3T/*n f- ui.--r -- INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only El Repair ❑Other System Type <A04-f/dw pi - okr_ _ 'etreatment Type >5 ft. from foundation? - e ��= \ -- ❑ N/A Ys ❑ No >50 ft. from wells? - C - �`5�. - -(1. - -- . ❑ g ❑ Z >50 ft. from surface water? - `\S -- - P� 1 0 ❑ HCleanout between building and tank? -- ' -� ❑ ❑ ❑ 0 Tank baffles present? - _ !_ _ - 0 ❑ ❑ d24"access risers over each compartment?- 6Y - 0 2 0 (W Effluent filter installed?- .- ElEr ❑ Septic tank size /5 Y2) gal Manufacturer /, t7Micr/1_r O D-box water level and speed levelers used? - - ,'N/A 0 YES 0 NO O Manifold/D-box accessible from surface?- - 4 �_IL1/C- Al-- 2 r- 0 GC Check valves installed? - - ❑ IC 0 m Transport Line Size 3 4 Schedule/Class 5d1 L j j Bedrooms installed (check one) ❑ 2 E]3 0 4 �5 0 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A cEs ❑ NO 0 >100 ft. from wells?- - El l2i ❑ W >100 ft. from surface water? - - ❑ V ID W >10 ft. from potable water lines?- - 0 Q 0 > 5 ft. from property lines and easements? 0 © 0 42 > 30 ft. from downgradient curtain/foundation drains? - - ❑ 2, ❑ Drainfield level and observation ports present - - El 14 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 ZPump tank size 1 gal Manufacturer /N Fr 1 -,fg7UI'V < 24"access riser(s)and accessible from surface?- - 0 E' ❑ 0. Alarm or Control Panel Installed? - - 0 ❑ dControl Panel equipped with Timer/ETM/ nter-.c Si P- 0 Cr al Pump installed in ❑ Bucket or On Block or [] Other Pump Make/Model Z-t €i teR I 2 I jalloats or ❑ Transducer Tank draw down Sj/UEM, in/min Pump capacity .549 gpm Squirt Height 7 p„ ft Pump on time a 7.5- M//t/ Pump off time 6 efrZ Daily flow set at 4160 gpd Updated 8121/2018 Mason County OSS installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES 444 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: Drainfleld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve dralnfield,existing and proposed bui'd ngs,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. 46-e"- 5;4f—, pPROVE MAR 1b2U23 MASON OddNTV ENVIRON • JB w MENTAL HEALTr ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER i certify that I Installed the system in accordance with 1 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 Maso ounty Codes. State and Mason County Codes I further ify that all i rmation contained on this I further certify that all information contained on this form a tacked d Dr s accurate. form and attached Record Drawing is accurate. Sig t re of Installer Date i,i r ijj / I , . 3 Z.3 &uiet1PV 1r4_ �� P - 8 � Printed Name of Signee . w4�045++ MASON COUNTY PUBLIC HEALTH :�`� F! J The undersigned approves this Installation Report and o� jAME 51w273 s�/+, S It.HUNTER . Record Drawing on behalf of Mason County Public 2`� i�CErisErh tx tc,idr-R 1� He,9ltC EXPPP.ES: 03/22/2' Sign. Environmental 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!2018 RECORD DRAWING (continued) E W 14--""-lts-ff 11 'V 1 y iA v fli tillz r h O Z n f . m112 I m • o 4.4 I0 in NI o CON �- zw I m n m nil V 0 %% / ,o \\ 1/s?��`\\\ ` \ tik W f A--i. w HOl1 ''4-' „, ^.. a ( , ` �� ' `` `' �, j �� a ` - V 0a � f \ 70 L., \-- n v 0 rrl v H m fim IN) m o I • �� ' �, - �` Z O �-Ul _ d W01 C - r mot 'rr -,; - �._. -1 co to 1 11 . - g _._ i -.1 i .." ,,,. (. ; i Cn z i- j ii ''s.'A'rn00 � tgit_C0 r � x i N CP \ 1 1 N j i ,