HomeMy WebLinkAboutSWG2020-00427 - SWG As-Built - 5/19/2023 1 9:-/
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
Permit Number SWG APPLICANT/ PERMIT INFORMATION
�m z U _��.c�Z7 Parcel # ZZ-(3 3 v3 d �03
Applicant Name g,�,,�.,.I 04-N D u47 Subdivision (Name/Div/Block/Lot)
Applicant Address PP, -f c ' 22/3 j�///�
City, State, Zip ft 79 f/ (,✓K ii. * 7 Installer Name < 4
Site Address 5-20 sE /42. //4-g Designer Name G?/leis"i F,,e,9g 4 '
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other
System Type Pr-e S'Se re Pretreatment Type yp 1�/�l itA4-Tt--,e. A-T(-1
>5 ft. from foundation? -
i 0iis-fti---- � .- ❑ N/A YES 0 NO
>50 ft.from wells? -
Y >50 ft,from surface water? - .�� _ � fl
_ 0 ® ❑
Z ❑ ® ❑
Cleanout between building and tank? 10�f_ __V Tank baffles present? - �
a24"access risers over each compartmen -_ _____ __ - ❑
W Effluent filter installed?- ❑ 0
cn -- - ® El 0
Septic tank capacity(working) 'eI"a-' UD gal Manufacturer
0 D-box water level and speed levelers used? - N/A ❑ YES 0 NO
�O Manifold/D-box accessible from surface?- (� ElRIElmz Check valves Installed? - - 0 ❑
GQ
2 Transport Line Size Z'41 Schedule/Class :°
Bedrooms installed (check one) ❑ 2 Ei 3 ❑4 0 5 0 6 0 Commercial/Other
>10 ft.from foundation?- - ❑ N/A 51 YES 0 NO
ci
>100 ft.from wells?- - ❑ 121, ❑
W >100 ft. from surface water? - - 0 0 0
ti >10 ft.from potable water lines?- - 0 Ea ❑
Z > 5 ft.from property lines and easements?- - 0 ® ElQ
Q >30 ft.from downgradient curtain/foundation drains? 0 El
Drainfield level and observation ports present - - 0 ® 0
0 Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 (S 0
Pump tank setbacks consistent with septic tank? - - 0 N/A YES 0 NO
Y Pump tank capacity(flood) 13 1) gal Manufacturer t e-fl4A- -/
Q24" access riser(s)and accessible from surface?- - 0 Ed 0
~ Alarm or Control Panel Installed? - - El IS El
a-
Control Panel equipped with Timer/ETM /Counter- - 0 ® ❑
a Pump installed in 0 Bucket or IJ On Block or ❑ Other
a Pump Make/Model �d gu-�2. l 2 ❑ Floats or El Transducer
2
a
Tank draw down Z�S in/min Pump capacity G;S gpm Squirt Height Cp ft
Pump on time 63-5k-c_ Pump off time 4/iS Daily flow set at 340 qpd
Updated 0/21n018
1 ,
Mason County OSS Installation Report pg. 2 Parcel# ?ZG 30 3 O 04030
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -
If yes, please describe: - ❑ YES
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El ® NO YES pasNo/1
RECORD DRAWING
This Is a permanent record and must be accurate and descriptive enough to re-locate In the need or 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 wells,waterlines,
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
f-' ` r 1 D p .r • '.4,q't 41 it ?Ae�G IA
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0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
1 I certify that l 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 mee 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 ' this
form and attached Record Drawing is accurate. form and attached Record Drawing is accu•.te.
/V'. #7 .— _ �,8 M`• � N J ,
b~ �`a �� ,i „�. �,�
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Signature of Installer Date
. r 7.
_abiPrinted ame of Signee J le
MASON COUNTY PUBLIC HEALTH .�`�cf. -
The undersigned approves this Installation Report and 1o.vA� . .
Record Drawing on behalf of Mason County Public T
Health: 4wrrec. ?/23 t O 2-3
(c ).,,,,i,,,,(cay, cliq (zI
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 8I21/2018
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�- Primary Drain Field OrM10e Ma 9N8'Diameter /J1/1p�5 k3�'LAl/�/ //✓ �Sc4,�i� GGG
:plowRosen"Drain Reid Orifice Spacing S/o_G.. 9// Sfz i42G4 D�/} Tz�
., i' ��� Hr�+* �Mlrf� Line Laiar�al Sloe ►��[r GjZ N GJ�s� SY�S�
i I :_"a * 1 Pr�aaaus Llf .iaas Depth of Cover Mr�bartal SL
•►= --51 .—VVaiar l.Unaoje 4$4,4'Fla� Trench /0-/z'weft l sw Pco8517
. , f.. �T-Septic Tank l�//.� Gel(1) Trench Width 3G
'° 44 �� I► i1 -taw Water ATU �097 Gal(2) Dosing .L..Doses.4o Gel/Dose Teat reet�ls
X �r.4 I -Purip Clamber,I�I teal(3) Screen�/n Pump Model f//SZ Distal}lead /
. ' _• -Monitor Port Pump Brand -rsL L Draw Dawn z.S"/m"1
a —Wel 'Timer Nzi MT-ce eterrEobi , Timor Beili'q. C.
(1)IFR il4 Modal ///4- oti
/-f141reftehs 4--+! Model /3/vi2 d Pl1"4:1 '"6. -6601 ° xtfz
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