HomeMy WebLinkAboutSWG2023-00152 - SWG As-Built - 6/2/2023 •
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG do_23 •vo/5 2 Parcel# 0 2,2_2 3 S/a 60 ?
Applicant Name Sc J -t c+ww9 si7 Subdivision (NamelDiv/Block/Lot)
Applicant Address 74/20 S /:fir /6 / 3 I Aa, TR'.t
City, State, Zip 0,-r owe 4012 aJ 4 .fd 3!1 Installer Name Ino,.y 1-1e,14/5/
Site Address ill'', F 7-,...71 z;AEI Designer Name r.'nil/ +..p, 1''0•P
INSTALLATION CHECKLIST
0 Full System Instaliation l�Tank(s)Only 0 Drainfield Only 0 Repair 0 Other
System Type Vey,/,., . -1-� K Pretreatment Type
-
>5 ft,from foundation? • - -- -- -- - ----- -- --' ---- -- CI N/A [OYES ❑ NO� ❑
>50 ft, from wells? - -- - - ( • t 1t 1. , ❑
>5O tt.from surface water? • l: ❑
Z ❑
H Cleanout between building and tank? - -- •.! -��Y-2-5 20-1L ❑ ❑
U Tank baffles present? • � ❑ L� ❑
a24"access risers over each compartment? • ❑ ,�/
W Effluent filter installed?• ILtl
U9
Septic tank capacity(working) tszhd gal Manufacturer 1•44-)rr4.4uJ
0 0-box water level and speed levelers used? NIA 9 YES j� NO
- --- - ❑ 0
�O ManifaldlD-box accessible from surface?- - --- -- - - - - - --- - - ❑ ❑
ci Z Check valves installed?
04 Schedule;Class
2 Transport Line Size
•
Bedrooms installed (check one) 0 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other❑ Yes �'No
>10 tt, from foundation?- • CI NIA
>100 ft,from wells?- • 0 0
2 >100 ft.from surface water? - 0 0
u- >10 ft.from potable water lines?- - 0 0
Zq > 5 ft.from property fines and easements?- -- - - 0 0 I
a >30 ft,from downgradient curtaintfoundation drains?- • 0 0
rj
0
Drainfield level and observation ports present - - - ❑
❑ Graveless chambers or 0Clean gravel used? (check one) 0 rn Ur
Proper cover Installed over drainfield? 0 -
Pump tank setbacks consistent with septic tank? - • 0 N,a
YES NO
Pump tank capacity (flood) gal Manufacturer
Z
24"access riser(s)and accessible from surface?- - 0 0
C-- -----1:0(
dAlarm or Control Panel Installed? • _ 0
2 Control Panel equipped with Timer/ETM/Counter- -- 0
a. Pump installed in 0 Bucket or ❑
On Block or ❑ Other
4- Pump Make/Model 0 Floats or ❑ Transducer
EL Tank draw down inlmin Pump capacity gPRt
)irk® V J- ft
Pump off time Daily flow set at apd
Pump on time JUN 0 2 2023 J`".482" J'n
MASON COUNTY ENVIRONMENTAL HE?I-T'
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Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - • CI YES (VN ,
If yes, please describe: _
Were all components pumped out and properly abandoned per WAC246-272A-0300? --- - - --- 0 YES lepi4o
RECORD DRAWING
TAh 0.a permanent record anti must be accurate and descriptive enough to Mee In Itle head et maintenance IcdVWles and rubes development. ToIon Recoil
prnµwtpt.iAnletn. Urn'nr.nld K manifold erlentalon A Mvvut.Sent?Jpumn tin*Mchta.1,North errva.nr<erve emwnFnlo westing and nrvr»tied bUdrinU%.Inemnn al wee!,wwterilres,
vwdta,d1snreiti c�Pxts.d4kr,iiuIP end d is'inaaatUMnea wow puMn. lntan'(A(1$Record 6mWnO MAY ueatn ntttdronat drtlays m FM.i irflaaate»41MM*rld rbintnd perw''rs.
0 Record Drawing Attached
CERTIFICATION OF INSTALLATION 4
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed to accor-
the septic design stamped`APPROVED"by Mason dance with the septic design stamped"APPROVED"by
County Public Health and that any deviations shown Meson County Public Health and that any deviations
hero 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. Slate and Mason County Codes
I 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.
Q r 1'--y..t 3
Slgttature of installer Date
no 4 •S WC/v1 tic
Printed Name of Signee'
MASON COUNTY PUBLIC HEALTH
The undersigned approves ti►is InstallatiohR OV
Record Draw' on behalf of Mason CoiftliThir
Health:
67z72 ) 0 i 2023
Signs re of Environmental Health SpecI&u( SON eetlisiTY ENViRJNMENTAL HEALTH (stamp. signature and date)
-
THIS FORM MAY BE SCANNED AND AVAILABLE 7't7R'Pl1BLIC VIEW ON THE MASON COUNTY WEB SITE ut"l"i"`i nntrtett,
RECORD DRAWING (continued)
.�e Ft/0 pAci
J
I vo 9\ e-
I �
DM) APPROVED
JUN 0 2 2023
MASON COUNTY ENVIRONMENTAL HEALTH