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HomeMy WebLinkAboutSWG2023-00127 - SWG As-Built - 6/9/2023 • -in County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION lit Number SWG 2023-&/21- Parcel # �201� 'SJ — °la�f: t Name 5-���c l/aww,S Subdivision (Name/Div/Block/Lot) ,,...nnt Address /;1-0 £ Scj.-o AFL- Gity, State, Zip Sf�c.(-�c� L�� agS$y Installer Name � � ��)k� 4� Site Address S r4-r"'1 E Designer Name C',`n 6si tAk.. tom-- INSTALLATION CHECKLIST VFull System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other ,,A,6 5a4 IQ A/K 14),4q--. ,j c442___ - - Pretreatment Type >5 ft. from foundation? - ❑ N/A $YES ❑ NO >50 ft. from wells? ❑ IX ❑ Z >50 ft. from surface water? - - - - ❑ iX1 El Cleanout between building and tank? - Ig ❑ ❑ U Tank baffles present? - ❑ ❑ 24"access risers over each compartment? • - - - - - - -- - - - -• - - - • ❑ g ❑ i_ffluent filter installed?• -11A ❑ ❑ 11 Septic tank capacity (working)_ _- _gal Manufacturer �� �S`� ��`J 0'ace.KeJE • box water level and speed levelers used? M N/A ❑ YES ❑ NO 1 snifold D-box accessible from surface?- - - - - 5if ❑ ❑ .;heck valves installed? - - ® ❑ ❑ .d 2 Transport Line Size asc ArZ TV Schedule/Class 90 i Bedrooms installed (check one) fg 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - N/A g YES ❑ NO >100 ft. from wells? - 1VI- f Te I ElLiW >100 ft. from surface water? - - ❑ u. >10 ft. from potable water lines?- - 1VtAY-3'I 26r3--, L ❑ - > 5 ft. from property lines and easements?- - L - ❑ Q Q > 30 ft. from downgradient curtain/foundation cjrryn -s? - - , - - - - ig- Elo I Y Drainfield level and observation ports present �- ❑ Graveless chambers or ® Clean gravel used? (check one)C 3?c---1 Proper cover installed over drainfield?- ❑ ki. ❑ Pump tank 5 tbacks consistent with septic tank? - - ❑ N/A Y.-YES ❑ NO IIrump tanfc capaf. food)' tfpgal Manufacturer e-c 1, L • 24. ac ,p risgr(s• and accessible from surface?- - ❑ M. ❑ ..,:.-n' Contrroi Panel Installed? - - ❑ 'g ❑ i • itrol Panel equipped.with Timer/ETM/Counter - - ❑ g ❑ Pump instralled in ❑ABucket or EA On Block or ❑ Other a. Pump Make/Model 4/ eitoGAJA 30 ri MO 50 Floats or ❑ Transducer R. Tank draw down 1, 5 in/min Pump capacity it( _ gpm Squirt Height J 24 ft R. Pump on time 21- 5 .c. ' Pump off time 3n:r1 ? f« Daily flow set at gpd Updated 8,2112018 back Mason County OSS Installation Report pg. 2 Parcel # ABANDONMENT RECORD Were existing septic components abandoned as part of this project? • - g YES El NO If yes, please describe: tx 61 •liept 16-f/a-IS 04cai"•trSy,td k Map«.,t,. 4 4 i 40p4,4y0o Were all components pumped out and p?bperly abandoned per WAC246-272A-0300? - - YES NO RECORD DRAWING o:manent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record •'lain. Dramfield&manifold orientation&layout,Septicipump lank location,North arrow.reserve drainfield,existing and proposed buildings location of wells.waterlines, • .r-.Minn ports cleanouts.and other maintenance access points Incomplete Record Drawings may create additional delays in final installation approval and related permits ,F-Record Drawing Attached CERTIFICATION OF INSTALLATION r - TALLER DESIGNER/ ENGINEER •.rtify that I installed the system in accordance with I certify that the system has been installed in accor- dance r,pt,C design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED"by v Public Health and that any deviations shown Mason County Public Health and that any deviations rave been cleared/approved by both the designer shown here have been cleared/approved by both .ii 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 D;,. ,ing is accurate. C2t_,_____e ..„,0„: %:: 5)3 ,i23 Signature of I staller Date •i- i`` (.'"--13 a4,14C4,S •;10. •ter ;:; Printed Name of Signee • - a Xr' IP•. . ..Salt r ' MASON COUNTY PUBLIC HEALTH r- 'A .,:• The undersigned approves this Installation Report and •... �` '''. Record Drawing on behalf of Mason County Public �d� . •4.ar Qict- "p�. ,1', . r!th W0- syy7AO ( f2 - 3 ;4P Ah,# !!:re of Environment Health Specialist Date !-; SA . si o , • . - a.,i..:3-.) T ‘C\9)\14/ ,rrc, c�c osc+c,rn 9 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON T,yit;u w•' .►r.U. %ti ;a vs"'41'. n ' i t.xPiu s .s.tu, E r RECORD DRAWING (continued) a \ 1 ki\11 ‘\4161/ VI__ i>.,vte w--.2' !1 . g/JQ - vI/ III:: ' - • (1g° ° ° 7 — 05, zis'AKi :4:' 1.5 i f:Irt. yoi tea, ;r.... ,,,. °IS IV o o 0o Do ° , `,h pd O__,w' i -i, APPROVED JUN 0 9 2023 M,SON COUNTY ENVIRONMENTAL HEALT i RET 1 1AJ ' c,,J e/PW.t,c J `5D' +/- 6ak lc,',' yi (, '•-f (... di 12, l0 c-de 1 /vi / j P a A au! ) ' 1' aft.t Co ,, .0 7 1 A-4 ,7�/74 ( 3W/ 5 Ye-a vt,. /7N- \ 32o io- so- cs 10.76 /Yra,Y Av4/j €e/0CSC sV 9 (/ A .pRE o,- • VELA f N.,_ 1A v Ill `� '� & MASpN TvN 0 9 2023 per' Ci D1 E41 A\ 5 ) NI'fv�R UCEN ,D DESIGNER \ / R�r N�&TAL HEAL Exr�iHtS US�tOt , / 6) Ee'c i J endc,e -\ 2-03 y7 © 6—g rshot (o o° Pr-e m i et- Z. 5-Z4.•6- aavt- Gffrry l� C7� U, CD POrnp va(&i4- 41- I\ \_---------- -- © O 1),4 ld v r lar Nf f\ �) 2uk- -r IQ. g.:,rsI t e.)9 5;4, r I2-2Y c.c.)w, ! ?"-"q:lle lq vt wa-r ' ,v - Sz "- PCl ,'yq q�dt x6 s X Pitt' w d h ® 1200 Cc 1r Q,) Pump f4,,,k . _ \o.urn um • 7_4.4_ Qff 1 v g lu k,c,N,`r,. -----_ _-I I C2) - __ _ ` 2 9 CIO ac4.ary vrsv Ql4ti� .0 6 ''' °19--- ---------- AO Or)t, s1o, 1 4-040sp 1, AN aM6 ) ( 2e, 1 lit" , t' ' ( \i\ / 2o, 1 so ,—