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HomeMy WebLinkAboutSWG2022-00191 - SWG As-Built - 4/12/2023 -7 Mason County OSS Installation Report pg. 1 / a , Q., MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG'C�2-00/V Parcel# /2 ' /9/ y 0.00 0 Applicant Name D,?z% Toi-��✓Sc rJ Subdivision (Name/Div/Block/Lot) Applicant Address .p o ��� ` S , ter` — o -/., - 3</ /c/,, City, State, Zip S/p c_/z),t/, U.' 98 r5,'-/ Installer Name ,c 'ss `o,-.ic e c Site Address `//'- c .s U'' i(.- Designer Name G.e,t,e/s /�c.s2-7-?_, INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type �i7„a v.Ti Pretreatment Type /�Ji� >5 ft. from foundation? - - 0 N/A it YES ❑ NO >50 ft.from wells? F.t; - -�`'- ❑ ❑ Z >50 ft.from surface water? - 11 - - ❑ ❑ HCleanout between building and tank? - - 11 - APR I-0-2 21--L .-- ❑ ❑ U Tank baffles present? - - ❑ i►! ❑ a24"access risers over each compartment'?BY _ - ❑ V] ❑ W Effluent filter installed?- - 0 sv lig ❑ Septic tank capacity(working) gal Manufacturer .e O D-box water level and speed levelers used? - - ❑ NIA 14 YES ❑ NO 0 Manifold/D-box accessible from surface?- - ❑ ® ❑ Cat Check valves installed? - - ❑ ❑ EM CS< Uu y S Transport Line Size 7 Schedule/Class. Bedrooms installed (check one) 02 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A YES ❑ NO 0 >100 ft. from wells?- - El El W >100 ft. from surface water? - - ❑ El u, >10 ft. from potable water lines?- - ❑ tii ❑ z >5 ft.from property lines and easements?- - ❑ ❑ a CZ > 30 ft.from downgradient curtain foundation drains?- - ❑ g El • Drainfield level and observation ports present - - ❑ M ❑ ��i Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ Ki ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ❑ YES ❑ NO Y Purrip--tank capacity(flood) gal Manufacturer - z �' ❑ -- ❑ ❑ < 24"access riseT(s).and accessible from surface? F- a Alarm or Control Panel In-Slatted?. -{] ❑ El S Control Panel equipped with Timer/ETtnter- ! - ❑ ❑ ❑ D n- Pump installed in ❑ Bucket or ❑ On Block or ❑ -___ Q. Pump Make/Model . -- - ❑ Floats or-____❑ Transducer '-______ CL a Tank draw down in/min Pump capacity gpm Squirt Height �-_ ft Pump on time Pump off time Daily flow set at __gpd Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES 0 If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES , ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re4ocate In the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout.Septic/pump tank location.North arrow.reserve drainfield.existing and proposed buildings.location of welts•waterlines. wells.observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. P 1) 01 APR 2 2O23 r. TY ENVIRONNIENIALHEA�7N RIASON c©uN gW ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER l certify that!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 1 further certify that all information contained on this i further certify that all information contained on this form and attached Record awing is accurate7/.7/ form and attached Record Drawing is accurate. • Mkt-. :1" Signature of Installer Date ~A 9 Zale: Printed Name of Signee MASON COUNTY PUBLIC HEALTH 2$808Q ' The undersigned approves this Installation Report and - ���� Record Drawing on behalf of Mason County Public. Health: _y :.— Signature of Environmental Health Specialist Date (stamp, signature and date) TUIC Cr,C]11I Al AV DC on. A Ain A\iA,, Ant t-r-r.n na int In,,,r-.il s . ki r.is-.....i II .IIn.i Al� l�l1G rr . ) k _1_:e?s"*.8 3.- - IIrQ:73 `.--:-1.--, % \ N i \ In te ;• o � r1 3 � i n � . \.... a --N\ W �? z k - ----7/ 11 c 1, m 8 m . / 71 \ Z r1 �1 • Y \ . \-- ::."st' i u ' .. '1 \ . '' . o\ r y3.7'� ti M. o CO NN �, 1 r---- 6,k:5r 000\ — t y A,17-.. or* LI ry \ ot, . 1'l • 1), 4 ,(-,\)„.. 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