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HomeMy WebLinkAboutSWG2019-00311 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1Q - ASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT I FO M ON Permit Number SWG ZO 1 t 0 c> 3 I 1 Parcel# \ 7.1 U$'- 5-t--3 t 0 0 S _ Applicant Name '11.-AS U Lf.vJ I I C- Subdivision (Name/Div/Block/Lot) Applicant Address 7 0 E L(1.1\9 1C,-f Q� City, State,Zip P ((,kN1 ,--1 CIS 52 9 Installer Name "1".0-1ti ;V tXCAVA'tSVt- Site Address '64-) t co --/o .6-a_ e\h .,,?rDesigner Name -3s.ty\. IA f-fI QY INSTALLATION CHECKLIST Ei Full System InstallationOnly 0 Repair ®Other`C Pcty a Y15 i;,IIV y 0 Tank(s)Only ❑ Drainfield System Type ?ttst45 ,txi. 'C CLf%q..14 Pretreatment Type told'1wfl i tt. (. N(Z-(aOO > from foundation? - \- _ 0 N/A 52 YES ❑ NO >50 ft.from wells? - ji .:-4 !^ ❑ ® ❑ >50 ft.from surface water? - :i6.-- 1El ill U Cleanout between building and tank? APR u 2023 C7j-_ 0 al ❑ C). Tank bathes present? - � I.- 0 0 0 E24"access risers over each compartrrt!ent?- ...... _ :----_�_ - 0 ® ❑ W. Effluent filter installed?- f r - ❑ En ❑ rA. . Septic tank capacity(working) 1 0 G gal Manufacturer 3 N F3 Li i I4.11,1-Oft` • 0 D-box water level and speed levelers used? - - EN1A Ell YES El NO DO Manifold/D-box accessible from surface?- -._ _ - ❑ fa m— Check valves installed? - 0 EN d Q I $U 2 Transport Line Size � Schedule/Class 5 CIA Bedrooms installed (check one) 0 2 ❑3 ❑4 121 5 0 6 ❑Commercial/Other >10 ft.from foundation?-- - ❑ WA El YES ❑ NO 0 >100 ft.from wells?- - 0 {J 0 w >100 ft.from surface water?- - ElEl u. >10 ft.from potable water lines?- - ❑ El 0 Z >5 ft.from property lines and easements?- El ® 0 d >30 ft. from downgradient curtain/foundation drains?- - ® 0 0 Drainfield level and observation ports present - - 0 ® 0 0 Graveless chambers or ❑ 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 ' W Pump tank capacity(flood) 1 SC)o gal Manufacturer T w F.1 LT 0L1-‘1 p{L 4 24"access riser(s)and accessible from surface?- - 0 ® 0 Alarm or Control Panel Installed? - 0 0 2 Control Panel equipped with Timer/ETM/Counter- - El •O, Pump installed in ❑ Bucket or C8 On Block or ❑ Other CI' Pump Make/Model Irk ert.-q • -It)0 e30 Q0 iA It Floats or E] Transducer a Tank draw down 3" - i rni n •p, in/min Pump capacity_ S gpm Squirt Height 7.- ft Pump on time 1 ttl Pump off time '4 kt).rs Daily flow set at tt SD gpd Updotod 8/21/2018 Mason County OSS irnst ilatLi rt Report pg.2 Parcel# ABANDONMENT RECORD were existing septic conY-^-'s ahzaa(-.ed as part of this project? - --- YES ❑ NO It yes,please describe: were all components ot.npee out and property a:,andorred per WAC246-272A-0300? - YES ❑ NO RECORD DRAWING Thi.+..p...,.n.^+n.+ed end ntiet be newton*and dsscr..e enough to to-locate a•the need of n ao,ananc.acli.MW bad Wee dsvelopnionl 'Nara Reccrl -a.ni.hd 6 ma dcl d1tnNehe,i layout.See-_•._-e 5!M bcaea+.Nor,,snow resew drr,Wd..acne and p.opneed buedr4o,locNan of noes.wat.nawa. wets._:t.-- c:,ru dcan•ou a.ad other ntteeeststde access:c-.7.Inconenele Rome Drawings may caeaay addo>,d delays n Ind rateeamor,awn*and**O&M D V\jjLD d-eLo mrn7s S vr\-Q-4) wffG2o - d000t Z [Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I codify that I installed the system in accordance with I certify that the system has been installed in accnr- 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 boon 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. .:—z 3- Signature of Installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and 51000121 F� Record Drawing on behalf of Mason County Public o� JIM HENRY fiealtty LICENSED DESIGNER�� V C _ / ( /�, EXPIRES: 08111%,Z Signature of Environmental .alth Specialist Date (/ (stamp.signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBUC VIEW ON THE MASON COUNTY WEB SITE rt.d en'oete • • 60' 60' 90' 0 -1-0-0 0 rn 0 80•.000®099 w \ Grapeviekv Point Rd ( -�_ O m-o v,Z m% › ). 6›P c ,o, c A \ \ 0m2mr^ 7)D mm4n,aD6,-aO g rTD ,r D � G)7G� G� c P c ° ootzZaoD�ymD � cA � � - -1KmpD o0 00 0K -° Eg V —°cr- m mm N-0a, nn° 2 ° Nc _ -no›o2 OJ0 mN00 = -0 JAA"' Dm2Z ZD -i --I °cccnH m L_Drn I I— m nZ -1m TDDKtnN r0° m 2° = = Oa � r -0rn m_J vz0 m N Z• _71n °o %K - Z ...:-)„ 44 ZI1M m i • \\ . 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