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HomeMy WebLinkAboutSWG2022-00306 - SWG As-Built - 4/7/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2CZ7_-• OU. (.-., Parcel # I a33(D ._.. ---a - C)c)0j Applicant Name _1 1A \ }-�pN` lC, Subdivision (Name/Div/Block/Lot) Applicant Address 50 Lk E )c-N Lrl City, State, Zip 13 o r 1 al R859A Installer Name -I-C1 C,r\ S110,1/40,e c- (Vi .1Ur,iipn) Site Address 5Vk (Gkr. on LiKe L Designer Name T-i''CA-\kr\ aCR r AIM 1. INSTALLATION CHECKLIST Full System Installation Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Cn.rC`i I VI-) 90(\. _ Pretreatment Type k f a >5 ft.from foundation? - - ❑ N/A ❑vES ❑ NO >50 ft. from wells? - - ❑ ❑ - ❑ >50 ft. from surface water? - - ❑ Er ❑ HCleanout between building and tank? - - El ❑ U Tank baffles present? - - ❑ Er ❑ a24"access risers over each compartment?- - 0 [ ❑ W Effluent filter installed?- - ❑ ffe- ❑ rn ( Septic tank size (a 0G gal Manufacturer )-1C).cvseb'Y ar S �rP cc,5-C- �0 D-box water level and speed levelers used? - - 0 N/A 9-1 s ❑ N• O DO Manifold/D-box accessible from surface?- - ❑ [I-- ❑ u. Oat Check valves installed? - - lK ❑ ❑ OQ 2 Transport Line Size Li Schedule/Class .3Q 3 Bedrooms installed (check one) ❑ 2 [r}t ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A n-YES ❑ N• O O >100 ft. from wells?- - ❑ [2- ❑ W >100 ft. from surface water? - - ❑ ©— ❑ u. >10 ft.from potable water lines?- - ❑ Er ❑ Z > 5 ft. from property lines and easements?- - El Er ❑ Q ixca El El 30 ft. from downgradient curtain/foundation drains? - - Cl Drainfield level and observation pot>present - - ❑ ❑ ❑ Graveless chambers or giClean gravel used? (check one) Proper cover installed over drainfield?- - ❑ [Efi ❑ Pump tank setbacks consistant with septic tank?- - El N/A ❑ YES ❑ N• O Pump tank size K/tC4 gal Manufacturer fJ I A < 24"access riser(s)and accessible from surface?- - E ❑ ❑ I- a. Alarm or Control Panel Installed? - 2 Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ Q/na- Pump installed in ❑ Bucket or LI On Block or ❑ Other a. • Pump Make/Model ND ) A ❑ Floats or ❑ Transducer 2 Tank draw down !v[4 in/min Pump capacity gpmSquirtHeight Fi Hei ht ,Q/ A- ft Pump on time ti'J ) t Pump off time N')Y Daily flow set at /f gpd Updated 812112018 Mason County OSS Installation Report pg. 2 Parcel# 130 -- cia - Obi 5 b ABANDONMENT RECORD Were any existing septic "componentslI abadoned as part of this project? - - YES NO If yes, please describe: Ex-t-S`t 1 rl CA V� t C f 3" ------------- Were all components pumped out and properly abandoned per WAC246-272A-0300? - - S (] 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: Drain'ield&manifold orientation&layout,Septidpwnp tank location,North arrow.reserve drainfiield.existing and proposed buildings.location of wells.waterlines. wets,observation ports,cieanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final instaration 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 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. lfa3l13 Si at a of Installer Dalle Printed Name of Signee 1: MASON COUNTY PUBLIC HEALTH fa .:I# The undersigned approves this Installation Report and i FRANKUNJClARK`;. et Record Drawing on behalf of Mason County Public � t l Health: °(Pt` : 01i2212023 Signature of Environment' Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 8i2112618 ...- .)-.... )10- . ui o)iel uosiel Q 75' • (in is I I i l L. CD EIMMI I '-'2 Fri i . T 'r . �•I iwa —...ram___..__— �f --! N DO Z n10 O m 2 73 73 5 O rn33 O z_ o C N m w rn 0 W z Op C) - I CDC) m i%% x a L -� 0 ffy_ %% to g QQ /A o D p' en o NOrh cNsi d . o o r NiOI��.'Y��� B n W'— -c CD 3 w�• / r 0