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HomeMy WebLinkAboutSWG021-00572 - SWG As-Built - 5/10/2023 Mason County OSS Installation Report pg. 1 U MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 202-1 - 05- ` Parcel# 3z_p z SscoOot-i 0 Applicant Name (-1E D L CSt-E12 Subdivision (Name/Div/Block/Lot) Applicant Address pceox 13q 9 City, State, Zip 5t.i-o-TAN Ma 9PS H Installer Name 7-ESNP Ekc_T Site Address S-/ 5 s` Ci oS(V EC.c. c.-N Designer Name n-p vi 'I+)(v re_ INSTALLATION CHECKLIST ull System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair 0 Other System Type R/V l2 (0 00 P/2E02-E'7 IL(/-)Pretreatment Type NUtrvz41t-12 >5 ft.from foundation? - -- ❑N/A ❑YES ❑ NO >50 ft.from wells? - - 0 0 Z >50 ft.from surface water? - _- CIEl < Cleanout between building and tank? - .- 0 ❑ V Tank baffles present? - - 0 0 a 24"access risers over each compartment?- - ❑ El El N Effluent filter installed?- - 01;f7. 0 Septic tank capacity(working) ibO0 gal Manufacturer SO.ND 0 LA-c n'l-E/11-r 0 D-box water level and speed levelers used? - N/A _ Es ❑ NO oO Manifold/D-box accessible from surface?- -l El Er CI QQ Check valves installed? - -- 0 E— 0 E Transport Line Size 2 " Schedule/Class c-/t. L� Bedrooms installed(check one) W2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- -- ❑ N/A [I-fEs ❑ NO 0 >100 ft.from wells?- - ❑ E El W >100 ft.from surface water? - - ❑ ©, ❑ Z >10 ft.from potable water lines?- - El ❑ 5 >5 ft.from property lines and easements?- - ❑ El >30 ft.from downgradient curtain/foundation drains?- - ❑ ❑ C3 Drainfield level and observation ports present - - 0 [1 ❑ El Graveless chambers or [lean gravel used? (check one) Proper cover installed over drainfield?- - 0 ❑ Pump tank setbacks consistent with septic tank?- - 0 N/A L ,ES ❑ NO Pump tank capacity(flood) /DD o gal Manufacturer SOL. A4 ?c-19-(-E-yvt Et\-;T Z < 24"access riser(s)and accessible from surface?- - 0 Er ❑ Fa.- Alarm or Control Panel Installed? - j Control Panel equipped with Timer/ETM/Counter- - El ©- 0 a Pump installed in ❑ Bucket or C2'6n Block or ❑ Other t Pump Make/Model"ZCELL L N ISZ- 1 3-Floats or ❑ Transducer n=. Tank draw down `I .s 'i in/min Pump capacity Z 0 qpm Squirt Height Z ft Pump on time vh‘lJ 30 SEA Pump off time Li 1412 S Daily flow set at 2-1-1 D gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# I ABANDONMENT RECORD Were existing septic components abandoned as part of this project? YES �pIf yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - D YES 0 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: Drainfleld&manifold orientation&layout,Septic/pump tank location.North arrow,reserve drainfield,existing and proposed buildings,location of weds.waterlines, wells,observation ports,deanouts.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 I certify that I installed the system in accordance with l 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/a and Mason County Public Health and meet all State pproved by both 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 l further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record D ' g is accurate. _ I2 2a � ure of l staffer Date �/ • /,� 3/• /,/ 3 Printed Name of SigneeMASON COUNTY PUBLIC HEALTH The undersi ned a 9 pproves this Installation Report and 0Record Drawing on behalf of Mason County Public .HUNTER :v Health: 10 i i.i.,,Ni::.; 1`l S'ti`N'f_ Y - Signature of Environmenta ealth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 i GOSNELL N S 7) K m -7-77 -= 4 Illlir cn C> D r m \ * v r - � 0 L J 0 m m x m z • % -4 -,/ r O // C C O0� 0 c r O n O r Z < 189• x O m v O N NJ X 01 `f 1 ,..__... m _ N(n W ii• r Z O. 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