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HomeMy WebLinkAboutSWG2021-00287 - SWG As-Built - 4/18/2023 Mason County OSS Installation Report pg. 1 . .C MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG Z0 2-1 — 00207 Parcel # t•7 .21 ( i 5n co 31 Applicant Name DRILL\? ? v\ c t Subdivision (Name/Div/Block/Lot) Applicant Address \sttl. NCI') rek14 of i -t City, State, Zip stw Lam► .vow q`3353 Installer Name Tr. 3S'A J 1-\4LT Site Address 31 E Pendragon Dr Designer Name ,c}-FE X b& t( t-) INSTALLATION CHECKLIST Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type PRESS utTE- TQ-&- C_t-F Pretreatment Type >5 ft. from foundation? - -- ❑ N/A 1 ES ❑ NO >50 ft.from wells? - ❑ Er ❑ • >50 ft. from surface water? - -- ❑ ❑ z EV El Q Cleanout between building and tank? - ❑ ✓ Tank baffles present? - ❑ [ ❑ 1: 24" access risers over each compartment? - - ❑ 2' ❑ W Effluent filter installed?- - ❑ ES1 ❑ galco Manufacturer //,/r/c_'1^IZX}-"t-P2 Septic tank capacity(working) I$'�o o D-box water level and speed levelers used? - - aN/A ❑ YES ❑ NO �J ❑ O Manifold/D-box accessible from surface?- - u. mZ Check valves installed? - -- ❑ 0' ❑ OQ Schedule/Class �� E Transport Line Size 7-11 Bedrooms installed (check one) ❑ 2 ❑3 3f ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - -- ❑ N/A (YES ❑ NO 0 >100 ft.from wells?- - ❑ a ❑ W >100 ft. from surface water? - - El Er ❑ a: >10 ft. from potable water lines?- - ❑ 2 ❑ z > 5 ft. from property lines and easements?- - ElEr ElE > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑' ❑ o Drainfield level and observation ports present - ❑ ❑ Cl [v'Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- '- ❑ Er ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ' YES U NO Pump tank capacity(flood) 1 SUo gal Manufacturer I onc.:00-nior2. < 24" access riser(s)and accessible from surface?- - ❑ Er ❑ ~ Alarm or Control Panel Installed? - - ❑ ❑ a E Control Panel equipped with Timer/ ETM /Counter- - ❑ Er ❑ m a. Pump installed in ❑ Bucket or Eren Block or ❑ Other a Pump Make/Model 6.-trite hll4N1'/w 5 s L-'ioats or ❑ fransducer a. a. Tank draw down Z ' ' in/min Pump capacity_ 55 _gpm Squirt Height _ 5 ft Pump on time_ 87 Seconds Pump off time 4 Hrs Daily flow set at_ 477 _gpd Updated 8/2112018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project'? • - ❑ YES ,� ❑ NO if yes, please describe: ,J Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑l� NO RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to rs-locate In the need of maintenance activities and future development. Typical Record Drawings contain: Dralnfield&manifold orientation&layout,Septic/pump tank location.North arrow,reserve drainfield,existing and proposed buildings,location of wells.waterlines, wells,observation porta.cleanouis.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 1 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 fo and art ched Record Drawing is accurate. form and attached Record Drawing is accurate. 7. 1el# 3 z2 ture o installer Date 1V--"SW S• Ft Cr �:• , Printed Name of Signee = ?� ,, •• ♦ ♦• ••5�1 MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and s+ooaea Lawrence '•;�'4, M.Purdum'• 'h, Record Drawing on behalf of Mason County Public = LICENSED DESIGNER '',, Health: .( t71\Q"\(\ " i(y) EXPIRES5 I23 Signature of 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 8r2t120+e '0 1, OOP OZ n m O�mO m N NTTr ; N; ZZ0 Amm> N T I N 2'51'18" E 160 .00'9 11E OM Li AZp> OOC 5 Im WAZ pO % yN t; 0 . % NZO > NO m - �omNp ' >= 4 pi= r.ONm ',Ur-' NNO = < 0 Zm 0 pOmmN2 m W,T O ,50 p Fc' ' n Z 1 ,Gm13 <-, . ,,x9 O Ig CS C F%n 0~ Om00 miA, "Iry i iA 0 AmDO >N2914 yyrA 28 )5OCD OONOmC Z A;� pm m lan9 >N>>A< AO Np Et_l 2tim 8~Q�j 0p6r AOnpA mrA >G 2nmp> 1DrW6L1 >20 > NNTO _<Z2 <pN w,E4mI n0 C y, 1,22O m r N Oro n NO;A X roZZ N .0 nn 2 , mNr 8 z A C) iN D - A 8 mm -.0>o>mzmCmCC oz7mz1D;070�7D(n (1) f v) o-O K•' X(nrm�NKDKK om-- D_D_D_r=(n V) m �� (OEm��-O"D �� nnF ZZZ-<� Z r nn up zKmDm0r(� O=mmD-T)-�-(nm mm m - k0KNm O -o DNNrrr m mc= •< 1 ZDmm m- ZZ 03o2)-4,. _, r(nN.3000>. 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