Loading...
HomeMy WebLinkAboutSWG2023-00236 - SWG As-Built - 6/30/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG202,3-0023ti Parcel # yaa a'S0-1 l®l a Applicant Name 'Tennicei Dump Subdivision (Name/Div/Block/Lot) Applicant Address iy@ Lake Taptx PkW'I . iO i-281 City, State, Zip Atd bif11 A1NA 98061' Installer Name WjJ 1es EXCo4va-hr'I3 Site Address t 80 N. Finch Greta*. Rd, Designer Name INSTALLATION CHECKLIST ❑ Full System Installation "Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type FigiVitl4 Pretreatment Type >5 ft. from foundation? - - ❑ N/A 'YES ❑ NO >50 ft.from wells? - il E C E Z5- V It ❑ El/ ❑ Z• >50 ft. from surface water? - - (I ❑ EY ❑ H Cleanout between building and tank? - -l�N 2 4-�3- - ((„ ❑ Di U Tank baffles present? - - ❑ [31/ ❑ a �� ---24" access risers over each compartment?- --------...,_- ❑ g 0 W Effluent filter installed?- .- ❑ [i ❑ Septic tank capacity (working) '0(1)@ gal Manufacturer 1(1€1 lfratI?r 5 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ ❑ ❑ OOZ Check valves installed? - - ❑ ❑ ❑ ❑Q 2 Transport Line Size Schedule/Class Bedrooms installed (check one) [D] 2 ❑ 3 ❑4 ❑ 5 0 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO O >100 ft. from wells?- - ❑ ❑ ❑ W >100 ft. from surface water? - - ❑ ❑ ❑ LI >10 ft.from potable water lines?- - ❑ ❑ ❑ Q Z > 5 ft. from property lines and easements?- - ❑ ❑ ❑ le > 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 consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tank capacity (flood) gal anufacturer Q24" access riser(s) and accessible from su ce?- - ❑ ❑ ❑ dAlarm or Control Panel Installed? - ❑ ❑ ❑ E Control Panel equipped with Timer/ ETM /Coun r - ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Bloc o ❑ Other a• Pump Make/Model ❑ Floats or ❑ Transducer d Tank draw down in/min P p capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8,21/2018 Mason County OSS Installation Report pg. 2 Parcel# ' 2a1(4"60-Ii012 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 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,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. l] 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. Signature of Installer Date Shane tv1 A p IPS Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: V_Ti\UN\r" C (30/2-' 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 8(21/2018 RECORD DRAWING (continued) •3 � APPROVED JUN 3 0 2023 MASON COUNTY ENVIRONMENTAL HEALTH RET m tt. 60.5' as.s' Gar port lN OUSt 1 New iotco ,n�Itrat�r - sephGMilK v' 00 `t . y le PGtXCC I $a21a-Sg�i i012 N• Fjn&h rretk, RBI.