HomeMy WebLinkAboutSWG2023-00142 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1 C 0 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023'CO 142 Parcel # 322 Ay^52^co4 17
Applicant Name LAeily t Subdivision (Name/Div/Block/Lot)
Anplicant Address /OZ aN'sr NC % 03
"1ty, State. Zip AW('3Lcad✓, Iw/A 'Adz- q7 Installer Name - / fL atR 114-
' Site Address to! hie A14rdang (-0- %g4stry Designer Name C t '/ WifIrE f
INSTALLATION CHECKLIST
LL��prFull System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Re-ib Ard_ Pretreatment Type —
>5 ft. from foundation? - - ❑ N/A Ki YES ❑ NO
>50 ft. from wells? - - ❑ gll ❑
>50 ft. from surface water? - ❑ I& ❑
Z R ElN CI
between building and tank? - - - -
U Tank baffles present? - - ❑ X ❑
iz 24"access risers over each compartment? - MAY 2-_ 2023_ _ _ - ❑ NI ❑
0.
W Effluent filter installed?- - ❑ KI ❑
Septic tank capacity(working) I 150 BY-Tar—'Nfanuracturer L.elf-41.-- COne-t"ek ENI 1114101
_0 D-box water level and speed levelers used? - - 'NIA ElYES ❑ NO
X0 Manifold/D-box accessible from surface?- ❑ ❑
:P� Check valves installed? - _ ❑ ❑ IN
..-7.ii2 Transport Line Size 2 Schedule/Class 140
Bedrooms installed (check one) X 2 ❑3 El 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - El N/A 51 YES El NO
. >100 ft. from wells?- - ❑ g ❑
i LLl >100 ft. from surface water? - - ❑ 1Y1 ❑
ti >10 ft. from potable water lines?- - ❑ 'in ❑
Q
z > 5 ft. from property lines and easements?- CI 'I& CI-
Q > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑
Drainfield level and observation ports present - - ❑ ❑
X Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ k ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A DYES ❑ NO
• Pump tank capacity (flood) 1287 gal Manufacturer 1r14I.17-�e IM- tar o
Z
• 24" access riser(s)and accessible from surface?- - ❑ ^g ❑
d Alarm or Control Panel Installed? - - ❑ CIE Control Panel equipped with Timer/ETM/Counter- - - - ❑ El
m
'` Pump installed in El Bucket or 171 On Block or ❑ Other
a. Pump Make/Model? reLL - #4- Floats or El Transducer
� ;it �
• Tank draw down__ 21_ __� lin/min Pump capacity / gpm Squirt Height to ft
Pump on time • �P — Pump off time ` Daily flow set at «0 gpd
U:.Oarr1 P.21:20111
Mason County OSS Installation Report pg. 2 Parcel# 2l y-52-evt of
ABANDONMENT RECORD
,vere existing septic components abandoned as part of this project? - - ❑ YES NO
If yes, please describe.
E ail components pumped out and properly abandoned per WAC246 272A 0300? YES 0 NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record
Drawings contain: Drainf eld&manifold orientation&layout,Septic'pump lank location,North arrow.reserve drainfield,existing and proposed buildings,location of wells.waterlines,
wells.observation ports.cteanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
11 ,45 ogi De544 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
l 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.
.0. 2-- g 13 le.141.7-3 41%.
Signature of Installer Date i ,��
Polo L3Artil�o� 1.1 1
i ,,,`"..1 )4
tinted Name of Signee ow. J_�41�,,, ioy�N, 1�
MASON COUNTY PUBLIC HEALTH `� d ! n 1 r
a, 5 04 ( �^
he undersigned approves this Installation Report and r LICENSED DESIGNER t1I
.ucord Drawing on behalf of Mason County Public i 1
*mom woo. w� ��"��I
"rc;alth: EXPIRES 05r10i
?..3-i\iskAie(CY1 LthZ--
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 y'21•2018
! t z
rJer�ti ,n APPROVED
JUN092023
MASON COUNTY ENVIRONMENTAL HEALTH
RET
51-1, SU ------) to/ '
S CD
l I �
1. RESIDENCE �f
2. AUDIO/VISUAL ALARM l
3. EXISTING 1150 SEPTIC TANK
4. 1200 CONCRETE PUMP TANK
5. TRANSPORT LINE
6. VALVE BOX _ _ Z
7. PRIMARY DRAINFIELD 2X67' LATERALS
8. WATER LINE
9. EXISTING FAILING DRAINFIELD
tee cle-v,rr cou !-
��� .) 3-2 / y-SZ- 6 4/0/7
q ‘I
d
e '''4 pff)/31/ )
t51il0
oo4.
C 18 F
e CINDY E WAITE
LICENSED DESIGNER
ExPIRES 05110'