HomeMy WebLinkAboutSWG2023-00364 - SWG As-Built - 6/23/2023 Mason County OSS Installation Report pg. 1 c+ c_ MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG2. -0030,1 Parcel #arIV j -ILi-- W07.
Applicant Name Britoil R ef- I,1e4g.!?Turnnv Subdivision (Name/Div/Block/Lot)
Applicant Address it GE FPxnvt0od i.ii• RarnCay
City, State, Zip Shelton IN4 g1S5SLd Installer Name Maples Ex a V2hr
Site Address .( L J 5E D W' VIU Pr Designer Name ICY] RUlteir&ASSO(�t2,Fe.
INSTALLATION CHECKLIST
l Full System Installation El Tank(s)Only ❑ Drainfield Only ❑Repair El Other
System Type elfoi\/ih" 3 Pretreatment Type
>5 ft.from foundation? - j ID N/A [ YES ❑ NO
>50 ft.from wells? - t :. ❑ Di ❑
Z >50 ft.from surface water? - b-\6`=... \--- - - ❑ ❑
-�Cleanout between building and t �-� � ---- ❑ [;}� 0
o Tank baffles present? - % --___ q:0: - ❑ GV ❑
d24"access risers over each comp nth---- -- ---- - - - ❑ [y ❑
W Effluent filter installed?- - - ❑ EY ❑
to
Septic tank capacity(working) gal Manufacturer ,�nyde(
0 D-box water level and speed levelers used? - . - ❑ N/A E•(YES ❑ NO
o
mO Manifold/D-box accessible from surface?- - CI [./ ❑
Z Check valves installed? - - CI CI [g
oQ
2 Transport Line Size " Schedule/Class scileciu It? 40
Bedrooms installed (check one) ❑ 2 ❑ 3 i4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A [ YES El NO
>100 ft.from wells?- 'III--r _ ---- ❑ [� ❑
--1 >100 ft.from surface water? - �J r -��I [� ❑
LT >10 ft.from potable water lines?- L� [� ❑
Q > 5 ft. from property lines and easements?- - -f+4,-1- JU�-4-01Mr, [ ❑
re > 30 ft.from downgradient curtain/foundation rAins?- - 1 Ig CI
• Drainfield level and observation parts present - [� 0
❑ Graveless chambers or Clean gravel used? (chec
Proper cover installed over drainfield?- - ❑ Li ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A El YES El NO
• Pump tank capacity(flood) gal Manufacturer
4 24"access riser(s)and accessible from surface. - ❑ ❑ ❑
~ Alarm or Control Panel Installed? - - ❑ ❑ ❑
a
2 Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑
m
a. Pump installA itio7114Ekkbr On Block �•r Other
O. Pump Make/ o el ❑ Floats or ❑ Transducer
• Tank draw down in Pump capacity gpm Squirt Height ft
a JUN 3 2 z0'1'�'
Pump on time Pump off time Daily flow set at gpd
h17130N(MUNI-YEW. .:;''- , -
-
Updated 821/201
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - E YES [] NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - D YES 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: Drainfield&manifold onentation&layout,Septic/pump tank location,North arrow,reserve drainfield,eldsting 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.
Si_ct—S ,4--<
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 D wing is accurate.
Signature of Installer Date
,�; �, i) -z
c2_\tiv� V14 -2
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ram., J
Printed Name of Signee •t
MASON COUNTY PUBLIC HEALTH p V ED
�w• a ; ��+�
The undersigned approves this Inststla�'on Repoit an '�;'�' 51!Jo:13 z.r:),04
Record Drawing on behalf of Mason County Public s O ' 6"` `�c!r-j �' 1
2 2013 1." rr.;Fr\rltCt�r�c.R
Health: JUN 3 s; . •VC7C< :1..s.-11.1\1116.11PfIt;
ZI 71043
Si ture of vironmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8212018
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