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Home My WebLink AboutSWG2023-00197 - SWG As-Built - 6/30/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG a03 OP0Igi Parcel # 520VY-50-60025 Applicant Name brad 1 ej 13onneUl Subdivision (Name/Div/Block/Lot) Applicant Address 2100 rtenolq Ave NUhWGif26I Seach TR23 City, State, Zip Al9tr Oft GYI.vvq cIg520 Installer Name Map1eS Excovcifirci Site Address 2-1,I LA- N6 hWGfzel Oeach Drpesigner Name INSTALLATION CHECKLIST ❑ Full System Installation j Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type eiraVikV1 Pretreatment Type >5 ft. from foundation? - - ❑ N/A 'YES ❑ NO >50 ft.from wells? - - ❑ ❑ 4 Z >50 ft. from surface water? - - ❑ ❑ • Cleanout between building and tank? - - ❑ ( ❑ U Tank baffles present? - - ❑ 4 ❑ d24"access risers over each compartment?- - ❑ [� ❑ W Effluent filter installed?- - ❑ Di_ ❑ Cl) Septic tank capacity (working) IP50 gal Manufacturer Roth El D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO OO Manifold/D-box accessible from surface?- - El ❑ I:9E Check valves installed? - - ❑ ❑ ❑ oa 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 [i3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A ❑ YES ❑ NO 0 C) >100 ft. from wells?- - ❑ ❑ ❑ U.1 >100 ft. from surface water? - - ❑ El El Er. >10 ft. from potable water lines?- - ❑ ❑ ❑ Z > 5 ft.from property lines and easements?- - ❑ ❑ ❑ ce > 30 ft.from downgradient curtain/foundation drains? - - ❑ ❑ ❑ o Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tank capacity (flood) gal M ufacturer Q 24" access riser(s) and accessible from surface. - - ❑ ❑ ❑ ~ Alarm or Control Panel Installed? - - ❑ ❑ ❑ a 2 Control Panel equipped with Timer/ETM /Counter- - - ❑ ❑ ❑ n a Pump installed in ❑ Bucket or ❑ On Block or Other a• Pump Make/Model ❑ Floats or ❑ Transducer a. a Tank draw down in/min Pum capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated a/21/2018 Mason County OSS Installation Report pg. 2 Parcel # 5a00L1 —550.-G O 3 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES ❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 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 orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. EiRecord 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. 671°11)3 Signature of Installer Date Shane Maples Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: 6 (30 12 3 Signature of Environ�Health Specialist Date (stamp, signature and date) 9 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8 21/2018 V. RECORD DRAWING (continued) <4.- -- -- f• v.1 58` . wtIt APPROVED .)U N 3 0 2023 MASON COUNTY ENVIRONMENTAL HEALTH RET new IZso roth septiotar'K i-t. a HOLM, • Neighbors welt rce I *5 aOAu-50r 09023 v0' vo t,-�er