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HomeMy WebLinkAboutSWG2020-00568 - SWG As-Built - 4/19/2023 Mason County OSS Installation Report pg. 1 C. C MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2i.- z - vo S C Parcel # ?2c/d - 5 J - _/i 1 Applicant Name ,,)@ 4,' S,.-,• 71A, Subdivision (Name/Div/Block/Lot) Applicant Address S'l,/ Sr /?),,/ Gk. _.5:Ao,•� ut, f7?-te0i c-,__ y'/. yid. /3 C. : G z/ City, State, Zip S,2,e./ v,., -/A„y / 98.' Installer Name y)>q,;,,, �. �=,L` Site Address -(7 �. ,x-AcG,-4.4,, _/4X Designer Name GA /,:r T /r AA,// INSTALLATION CHECKLIST utl System Installation ❑Tank(s)Only ❑ Drainl-field Only ❑Repair ❑Other System Type /ass - T•^e.-.c_1-7 Pretreatment Type 42T✓: '3A/i. s''O /14i4“_,- >5 ft. from foundation? - - ❑ WA pi YES ❑ No >50 ft. from wells? - - El .0 El Z >50 ft. from surface water? - - ❑ El I-- 0 El between building and tank? - - ❑ U Tank baffles present? - - ❑ 16 ❑ P 24"access risers over each compartment?- - ❑ 4EI El W Effluent filter installed?- - 0 ❑ ❑ to Septic tank capacity (working) lO gal Manufacturer ,A..fi-, l T!c,.Tt+r- C3 D-box water level and speed levelers used? - - -- - 6 NiA ❑YES ❑ No XO Manifold/D-box accessible from surface?- • El El El on Z Check valves installed? - - El ❑ El 6 Q 2 Transport Line Size Z'4 Schedule/Class LA U Bedrooms installed (check one) 2 03 ❑4 ❑ 5 0 6 ❑CommerciaUOther >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO >100 ft from wells? • - ❑ WI ❑ o W >100 ft. from surface water? - ❑ El El Er. >10 ft. from potable water lines?- s ld.) - - - - ❑ El ❑ Z > 5 ft. from property lines and easements?- - ❑ gj El IX > 30 ft_from downgradient curtain/foundation drains? - - ❑ ® ❑ Drainfield level and observation ports present - El ® ❑ © Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- ❑ ( ❑ Pump tank setbacks consistent with septic tank? NIA Q YES ❑ too t > > Pump tank capacity(flood) i 060 gal Manufacturer .1 LA.(- 1 ► rq-ci1?e__ cc) < 24" access riser(s)and accessible from surface?- - ❑ Q ❑ a I- -Alarm or Control Panel Installed? - El El Ela w 2 Control Panel equipped with Timer I ETM/Counter- - - ❑ Z El i- Pump installed in ❑ Bucket or On Block or ❑ Other a. Pump Make/Model illI ,S-Z 0 Zs) (,( "--- gi Floats or 0 Transducer a Tank draw down in/min Pump capacity fy gpm Squirt Height 8 ' ft Pump on time / s"--M•ci Pump off time 5--a /n Daily flow set at 2-VC) qpd , 1-:,J.-Ye6 K21,265d aiirrlrlrr Mason County OSS Installation Report pg. 2 Parcel# 32oi6 - 3 3 -osaZ / ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - la-g If yes, please describe: 0 YES Were all components pumped out and properly abandoned per WAC246-272A-0300? - ElYES ❑ 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 Drawings contain: Drainfield&manifold orientation E layout Septic/pump lank location.North arrow.res ra;r erve dfiedd-existing and proposed buildings.location of wells, s,wa wa Recordter;nee. wells,observation pores.cleanouts,and other maintenar ce arne,s paints Incomplete Record Drawings may create additional delays in final instaiation approval and related permits. ecord 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 a ed Record Drawing is accurate. form and attached Record Drawing is accurate. t 744C2.. <fr- /&2_3 • Signature of Installer Date Elj�r a. Printed Name of Signee , MASON COUNTY PUBLIC HEALTH -. The undersigned approves this installation Report and - e) ,p 28508 p rr Record Drawing on behalf of Mason County Public 8 NA SIL%Itg 4 1 Health: I�a ( 4/-1/ L3 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 8121/2" r, 1tIv cle, d ��. z 4- o � v A —._ _ �; m m ,OR/1, 4 ,41yI - ' II 0\—____ m ' NI Op) \ N 0 o \--.% \TA, v, „ , ), p , :tt (., x, ON s c,. \- -, O 1 • O 0. ZINC. 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