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HomeMy WebLinkAboutSWG2023-00154 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG2g -0015`-f Parcel # 3 ?J- CIG-000'0 Applicant Name EVadn glacicweII Subdivision (Name/Div/Block/Lot) Applicant Address 230 sE O -t r peach Qd• Lot 0• SCC•ZI R 3W Twnshp IGi City, State, Zip ShC fttf,WA 1$5gt-1 Installer Name Mapt fX CAW-I:1(19 Site Address 2-90 SE O'(Sttr geqcil 2d_ Designer Name INSTALLATION CHECKLIST ❑ Full System Installation 'Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Pretreatment Type >5 ft. from foundation? - - ❑ N/A 'YES ❑ NO >50 ft.from wells? - " [Jf ❑ >50 ft.from surface water? - [v� ❑ Cleanout between building and tank? - r___7_ , .L- L ❑ (� ❑ V Tank baffles present? - - ❑ � ❑H 24" access risers over each compartment?- - -- - - - ❑ ❑ `W Effluent filter installed?- ., •- (�� ❑ ❑ Septic tank capacity (working) I©&0 gal Manufacturer I n-Fi H-1'nity( 0 D-box water level and speed levelers used? - - ElN/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - El El 0;12 Check valves installed? - - ❑ ❑ ❑ oQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A ❑ YES ❑ NO 0 >100 ft.from wells?- - ❑ ❑ ❑ u.1 >100 ft.from surface water? - - ❑ El El LL >10 ft.from potable water lines?- - ❑ ❑ ❑ Z Q > 5 ft. from property lines and easements?- - El El CL > 30 ft.from downgradient curtain/foundation drains? - - ❑ ❑ ❑ CI Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A d YES ❑ NO • Pump tank capacity (flood) gal Manufacturer / /14C�Cl Q 24" access riser(s) and accessible from surface?- - ❑ e� ❑ .... a. Alarm or Control Panel Installed? - - El1a El E Control Panel equipped with Timer/ETM Counter- - ❑ ❑ m a- Pump installed in ❑ Bucket or',( On Block or ❑ Other O. Pump Make/Model Zvi der ( ) )5.--z.- ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height _ ft Pump on time Pump off time Daily flow set at _ gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# ?lcf2 fE-0( g0 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES d NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES d NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to relocate 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 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. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I 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 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. Signature of Installer Date Shane Mapes Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: 6 ( '(z-5 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 8i2ti2018 ii • RECORD DRAWING (continued) SEOSex44- 1 1'3 p -uistieg septic s4Stcm Lbd 16188 d otSbNit-t- ( Rome WAS removed) flMvtrC tiny ^� - house LoCAtion r-----7, o0 r El o R f-- ° —10100 infi orator-tanK well Wrlh Midlc Purnell 1i-fi• to into of SCpti( \\ tarn 1c. �y•2` aA& t{1�,t6G ck e`er ROV EDP I 41..3, p,P P .01 09 2023 '‘ 9 MA SON COOT'i ENVIRON!�EhI AL HEALZ�' RAT n a0 •3. WateAc pa rcu *3161?I-'-000n