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Home My WebLink AboutSWG2022-00260 - SWG As-Built - 6/30/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG2022-002(00 Parcel # ?) ( -50)-@@03L0 Applicant Name eion j OLSOil Subdivision (Name/Div/Block/Lot) Applicant Address l 10(p5 2yIst Ave, SE City, State, Zip Maple Val ley 4 A°1 X038 Installer Name Maple. ExC VOItl, 19 Site Address td181 E. mcisDn Oerton Rd. Designer Name INSTALLATION CHECKLIST ❑ Full System Installation d Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Pressure Pretreatment Type >5 ft.from foundation? - - ❑ N/A [ YES ❑ NO >50 ft. from wells? - •- ❑ [� ❑ >50 ft. from surface water? - - ❑ El ❑ H El [I El between building and tank? - - V Tank baffles present? - - ❑ [/ ❑ d24"access risers over each compartment?- - ElL5 CI W Effluent filter installed?- - ❑ a ❑ U) Septic tank capacity(working) i2.50 gal Manufacturer Ro-th 9 D-box water level and speed levelers used? - - ❑ N/A ElYES ❑ NO DO Manifold/D-box accessible from surface?- - CI CI OOZ Check valves installed? - - ❑ ❑ ❑ OQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 12(2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A ❑ YES ❑ NO >100 ft.from wells?- - -11�1Fj ❑ ❑ „,--1 >100 ft. from surface water? U- II ❑ El IT. ft. from potable water lines?- . i. - JUN -2-8-ta23 LI ❑ ❑ Q > 5 ft. from property lines and easements?- - - - - I - ❑ ❑ re > 30 ft.from downgradient curtain/foundation drain k- - - - - ❑ ❑ ❑ • Drainfield level and observation ports present - - ❑ ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A BYES ❑ NO Pump tank capacity (flood) Ij gal Manufacturer Ph < 24" access riser(s) and accessible from surface?- - ❑ [3/ ❑ H a Alarm or Control Panel Installed? - - ❑ p' ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ Di ❑ D 13- Pump installed in ❑ Bucket or dOn Block or ❑ Other CL Pump Make/Model ZOciity N 1S?' [Floats or ❑ Transducer 0. a Tank draw down in/min Pump 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 # ;2103-50-0003(0 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - [f YES n NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - [ YES El 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. [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. iiS13 Signature of Installer Date Shan, vlapi 6 Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: t(LAI of Environmen�ealth Specialist Date Signature p (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8i21f2018 I RECORD DRAWING (continued) E- Mclsort Benson Rd• APPRO V�� MASON ��N 3 0 2023 COUNTYfNVTRONM a RET ENTA1 HEALTH n -f r o0 -144 seek V � WAt �1 Parc€l 4P:aa103-5e-e@031a