HomeMy WebLinkAboutSWG2021-00676 - SWG As-Built - 4/12/2023 Mason County OSS Installation Report pg. I .C� MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG zap /— oa67 6 Parcel # 6/73D — So — Q2-0o1
Applicant Name /°',(//ui/' /49,,rz4,t2 Subdivision (Name/Div/Block/Lot)
Applicant Address 4/706 C4i.4.4, cr. se 54,1"000 r/-0P44r 4460 G 3 z e- 7
City, State, Zip O.ym o',q , $4,4 98rv)- E.ovInstaller Name froasi e3 zos.
Site Address /2/ Gt./• -i4i �,44e " -' Designer Name a/s fie-si724vr
.441r44N�l1 ,i/vs.,z.4.rR/4r6
INSTALLATION CHECKLIST
Full System installation 0 Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type /2,-crc-.'c._ — ,?e br/G,y' Pretreatment Type
>5 ft. from foundation? - - ❑ NIA }YES ❑ NO
>50 ft. from wells? - ❑ ❑
Y >50 ft. from surface water? - ►F}I ❑ ❑
Z LL}}ty�
Cleanout between building and tank? - ` P -Q4-2021— ❑ ® II]
V Tank baffles present? - SY - ❑ ill
E-- 24" access risers over each compartment?- —,...---- ❑ Q ❑
W Effluent filter installed?- - 0 ID ❑
N
Septic tank capacity (working) 112.5 gal Manufacturer l-I i3
D w a s levelers NIA ❑ YES El NO
u_ Manifold-box /Dater-box level ea lc; from surface?used? - - T'A ❑ ❑
2 Check valves installed? - - El ❑
`t 1 t Schedule/Class u El
Transport Line Size c.
Bedrooms installed (check one) 0 2 ® 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ NIA Q YES ❑ NO
>100 ft. from wells?- - El ® 0
W >100 ft. from surface water? - -
0 El ❑
ti >10 ft. from potable water lines?- - ❑ ® 0
Q > 5 ft.from property lines and easements?- - Cl IJ ❑
et > 30 ft.from downgradient curtain/foundation drains? - - ❑ Q ❑
Drainfield level and observation ports present - - ❑ ❑ ❑
0 Graveless chambers or E Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ , ❑
Pump tank setbacks consistent with septic tank? - ❑ NIA Q YES ❑ NO
Y Pump tank capacity (flood) J-2.5Q gal Manufacturer i{I>
< 24" access riser(s) and accessible from surface?- - ❑ ® ❑
I^
G. Alarm or Control Panel Installed? - ❑ ® ❑
E Control Panel equipped with Timer/ETM /Counter- - ❑ [ ❑
n- Pump installed in ❑ Bucket or ® On Block or 0 Other
n- Pump Make/Model {l1p t1t 'i C. 8 v-40 Floats or ❑ Transducer
R. Tank draw down ' 1"1 in/min Pump capacity .3 gpm Squirt Height tS ft
Pump on time 3 tr) ' n Pump off time ( lir Daily flow set at 360 _gpd
Updated 8121/2018
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
abandoned aspart of this project? - - �] YES IQ NO
Were existing septic components
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - [] YES N/A ❑ 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: Drainfield 8 manifold orientation 8 layout,Septic/pump tank location.North arrow,reserve drainfield.existing end proposed buildings,location of wells,waterlines.
wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
- 4APPRo
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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 andnd Mason
n CoCounty
ty Public
ub i Health and meet all
and Mason County Codes.
s
I further ce that all information contained on this i further certify that all information contained on this
form and a .+hed R- ord Drawing is accurate.
23-0 form and attached Record Drawing is accurate.
i;�_/./,tom- >! .
• Date ,it I<d qy+ `a ,=-,5
Signaftrr: of 1 st�tl:r 'T A, s.•?„
Printed Name of Srgnee id r 9 Z I•
F�
MASON COUNTY PUBLIC HEALTH x,® 28508
The undersigned approves this Installation Report and .. s /ZIPF*�OggE�� C'
Record Drawing on behalf
of Mason County Public r-..,.ic) .
� �-;
He 2r � 7— 23
Sign fur nvironmental Health Specialist Date
(stamp, signature and date)
f THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated aiztizota
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