Loading...
HomeMy WebLinkAboutSWG2021-00477 - SWG As-Built - 5/16/2023 imcmiriv,, M �23 AY122 1 Mason County OSS Installation Report pg. . ASON COUNTY PUBLIC R AE LTH APPLICANT/ PERIRtTiNFORMATION Permit Number SW f 1 - —1 Parcel # '•7f:71i._c:73-( I?j Applicant Name NSIC IS1TI 1— Subdivision (Name/Div/Block/Lot) Applicant AddresscfrmL S S . 1 (0.4i1st. lH-H City, State, Zip -bille tk CI$1L Installer Name Site Addresst � � � r ��Q �t�G LOC �,�()t' C_�; Designer Name 1 t rii INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Lot° f ce,5SLr f, Pretreatment Type >5 ft.from foundation? - - ❑ N/A KI YES ❑ NO >50 ft.from wells? - .- ❑ 14 0 z >50 ft.from surface water? - - 0 Ea 0 H Cleanout between building and tank? - - ID RI ID U Tank baffles present? - - 0 ® 0 a24"access risers over each compartment?- - 0 El ID N Effluent filter installed?- .- ❑ i Q 0 Septic tank capacity(working) % atid gal Manufacturer 5nk4 car o D-box water level and speed levelers used? - - © NIA ❑ YES ❑ NO p0 Manifold/D-box accessible from surface?- - ❑ El In— Check valves installed? - - 0 El ElGQ 2 Transport Line Size i�! Schedule/Class Li O Bedrooms installed (check one) ❑ 2 g1 3 ❑4 ❑ 5 0 6 0 Commercial/Other >10 ft.from foundation?- - ❑ N/A ® YES ❑ NO 0 >100 ft. from wells?- - 0 El W >100 ft. from surface water? - - ❑ ® 0 a >10 ft. from potable water lines?- - 0 El 0 Z > 5 ft. from property lines and easements?- - El El ❑ Q ce > 30 ft.from downgradient curtain/foundation drains? - - 0 En 0 Drainfield level and observation ports present - - ❑ ® 0 ® Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 © 0 Pump tank setbacks consistent with septic tank?- - 0 N/A ® YES 0 NO Pump tank capacity(flood) /1,1-e, gal Manufacturer 5 cjC(- < 24"access riser(s)and accessible from surface?- - El 0 G. Alarm or Control Panel Installed? - - 0 ® 0 Control Panel equipped with Timer/ ETM /Counter- - 0 ® 0 aa. Pump installed in ® Bucket or 0 On Block or ❑ Other n- Pump Make/Model 2-otIc,r in-- [ Floats or El Transducer a Tank draw down I IL�- in/min Pump capacity `-343 gpm Squirt Height .2..! ft Pump on time J N\i A Pump off time 3 LrS Daily flow set at 31)0 gpd Updated 8:212C 18 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - D YES ® NO 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 bo accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typcal Record Drawings contain. Drainfield 8 manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfeld.casting and proposed buildings.location of wells,waterlines wells.observation ports,clear outs.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 1 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 Drawing is accurate. form and attached Record Drawing is accurate. Signature Installer Date keolbvti-\ Printed NanOof Signee Q �d • MASON COUNTY PUBLIC HEALTH '• \5' The undersigned approves this Installation Report and `�' •� ^ 9' PP P Record Drawing on behalf of Mason County Public ^ -a Health: ` ''„Qti\Q}(v\ocit.1 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 et21/21)111 o it1. - F-C "'<n� N1 � ) zz 2 v 0 0 H! !1 -'77".' -13 51 /: � � - 4 50' O . N o. X < Ca 5 m �o a7J cz - `Mr.AIHi OH35 ng*il n > 000d03s C ; . • ,p8 • o �} 0 l s3 3 d 0 H So 3 a -. ti a w 70 � g x R i ii lid H Hd dR p ow Z m > Z H 0 'ts �s Q: 0 cu ce “ O cD �p .». w I-, '' l'-' ° cp AP , ;. . g ro pp.' g a � rARy ,�_� ._ ttm�� c �' . . a u ° c �; 5 S' S• O 5 (), - .... •-t)-3 -1 cl) 0 0 ti It l'A 11' . \11 ij —\) --) 1r41. kit Oi 6 I 4 (9 g qp,, R 8 t $rf .1)6" T k-1\ -3 11 al R --12-\- V • Ul y U itrC r.CO-N�S(1 . M .1:0 arir !f NI NI "ni 'rnrn r n v � ��� C9 t, `. \ 4\ ''' - h I:.