The URL can be used to link to this page

Home My WebLink AboutSWG2022-00586 - SWG As-Built - 6/30/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG)®ad-0058(O Parcel #216I01 - 50-00020 Applicant Name Sh ir►ey House Subdivision (Name/Div/Block/Lot) Applicant Address 33 e. Q j' Dr. I HOrStine Island � 4-Grte City, State, Zip Sh1,1tOV1,LJA 11g5g`1 Installer Name VI 4.49 S EXCuVq-hnC Site Address E- DAX1a., Dr- Designer Name INSTALLATION CHECKLIST ❑ Full System Installation liTank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type &IraVltvj Pretreatment Type >5 ft.from foundation? - - ❑ N/A OYES ❑ NO >50 ft. from wells? - - l ' ii-(ur-1-� ❑ 5 ❑ Z >50 ft. from surface water? - -�- ElEl Q Cleanout between building and tank? - - - L-J -1 $-2flH-- ❑ -Er ❑ U Tank baffles present? - I Lr- ❑ Er ❑ et III- 24"access risers over each compartment?it gym- 4 - ❑ Z ❑ W Effluent filter installed?- - ❑ Al ❑ `o I01�� I nfi ItrCitfl Septic tank sizegal Manufacturer r 5 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ ❑ ❑ OOz Check valves installed? - - ❑ ❑ ❑ 0Q 2 Transport Line Size Schedule/Class Bedrooms installed (check one) Ell 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO >100 ft. from wells?- - ❑ ❑ ❑ W >100 ft. from surface water? - - El ❑ El >10 ft.from potable water lines?- - ❑ ❑ ❑ Z > 5 ft.from property lines and easements?- - ❑ ❑ ❑ Ce > 30 ft.from downgradient curtain/foundation drains? - - ❑ ❑ ❑ • Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tank size gal Manuf-• urer Q 24" access riser(s) and accessible from su ce?- - - ❑ 0 ❑ ~ Alarm or Control Panel Installed? - - ❑ 0 ❑ a E Control Panel equipped with Timer/ETM / •unte - - ❑ ❑ 0 n a. Pump installed in ❑ Bucket or ❑ 2in Block or • Other 2 Pump Make/Model 0 Floats or 0 Transducer a. a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 812t12018 Mason County OSS Installation Report pg. 2 Parcel# Z I010I -- 50 - 000P0 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - [B YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - d 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: Drainfield&manifold orientation&layout,Septic/pump tank 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. [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. (t)I-1It3 Signature of Installer Date Shaxic Ma,p16� Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: 1`) (;o173 Signature of Environments Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8,21/2018 RECORD DRAWING (continued) <1 • p • v,iafieX�� ► � —4 0 0 HOLM, failed-rank dccomm%sfiw ,, Nap.) 10190 infiltrntVr sepr&i-itnV-. ScxnG LOcAtiOn- APPROVED JUN 3 0 2023 MASON COUNTY ENVIRONMENTAL HEALTH RET ,- \�, E• DG)h Gi Dr. Parce2-4a1gj1-50- 000a0