HomeMy WebLinkAboutUntitled (1771) • A e
.1n County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
•,tit Number SWG 002lo8 Parcel # -2124- 75 -gdpy.)
Name .,oit� tG-kY Subdivision (Name/Div/Block/Lot)
:Ant Address l2Q Cr- ?I I ecL4 ft)(.... —�,- .^
'City, State, Zip 5-ne-tr t art- 1$58'-) Installer Name "�O SI�f2c -pca, U6,S�
ISite Address 5„„71,,,8- Designer Name
INSTALLATION CHECKLIST
❑ Full System Installatio [ ank(s Only ❑ Grainfield Only ❑Repair El Other
System Type SO((O 1r1 Pretreatment Type
>5 ft.from foundation? - - El N/A K YES ❑ NO
>50 ft. from wells? - - ❑ Cl
Z >50 ft. from surface water? - - ❑ ❑
FQ- Cleanout between building and tank? . - ❑ CIo Tank baffles present? - - V •v ❑
:'-1"access risers over each compartment?- ❑ ❑
.`k ant filter installed?. -/�1,,,. ,��, ❑ ❑
'.:, ptic tank capacity (working) ' ________gal Manufacturer �,�r�1Ck.�
-'10x water level and speed levelers used? - - - - -- - N/A ❑ YES El NO
• :: r:;foid D-box accessible from surface? 0
• Uneck valves installed? - . 0 ❑
a Q 11lia
E Transport Line Size . Schedule/Class
Bedrooms installed (check one) ❑ 2 / ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ❑ YES 0 NO
0 >100 ft. from wells?- ❑ ❑ 0
W >100 ft. from surface water? - ❑ ❑ 0
u.. >10 ft.from potable water lines? - ❑ ❑ ❑
Z
Q > 5 ft. from property lines and ease CI ❑
0 > 30 ft. from downgradient c in/foundation drains? - - 0 0 ❑
Drainfield level and ob rvation ports present - - ❑ 0 0
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑ ❑
,p tank setbacks consistent with septic tank? - - ❑ N/A YES 0 NO
' r,•p lank capacity (flood)_ gal Manufacturer
access riser(s)and accessible from surface?- - - - 0 CI
car Control Panel Installed? - - - - - - - ❑ Pf ❑
-ar:,l Panel equipped
q pped with Timer/ETM/Coun
Pump installed in Bucket or ❑ lock or ❑ Other �<<"`✓ P� �
_
n.
2 Pump Make/Mode _ t _ -�07 _ litFloats or ❑ Transducer
d Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time oN m/0. Pump off time Daily flow set at gpd
!cdnte•d 8.211201 e
c t -
Mason County OSS Installation Report pg. 2 Parcel # 22 )2.Li - 75 9061/7
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? - - -Ml-- El YES ❑ NO
RECORD DRAWING
• -.n.maneet record and must be accurate and descriptive enough to re-locale in the need of maintenance activities and future development. Typical Record
Pr.nr:lield 5 mandoid orientation 8 layout,Septic/pump lank local:on,NOrtn arrow.reserve drainhrid,existing and proposed buildings.location of wells,waterlines.
u.•; cleanems.Anti ohm maintenance access points. Ir:xm:plole Record Drawings may create additional delays ie final installation approval and related perm ts.
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
.:TALLER DESIGNER/ENGINEER
r,rn,that I installed the system in accordance with I certify that the system has been installed in accor-
•• :,t=ptic design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED"by
r Public Health and that any deviations shown Mason County Public Health and that any deviations
t been cleared approved by both the designer shown here have been cleared/approved by both
•:-icon County Public Health and meet all State myself and Mason County Public Health and meet all
. Mason County Codes. State and Mason County Codes
!further certify that all information contained on this /further certify that all information contained on this
form and attacl Record Drawing is accurate. form and attached Record Drawing is accurate.
b/ o/
Signature of Installer Date
-Thal fz7'd
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health
SZ,IVIA44011/1 6(56(z,3
,!Environmental Health Specialist Date (stamp. signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE trpooted a.t2u2ota
•
MASON COUNTY APPROVED
•
GENERAL SERVICES DEPARTMENT JUN 30 2023
P.O.BOX t 86 a 426 WEST CEDAR o SHELTON,WA 98584
PHONE(206)42 7-96 70 UASON . 10-:'!fir ANgTAVlfde'rH
RECORD F FINAL INSPECTION OF YOUR SEWAGE DISPOSAL S`a.r..•°,.T r
CWNER�G� 5-I so,,, fiy S '
t N 5 d /J S G�J� ADDRESS S �' �'
THIS RECORD IS NOT A GUARANI OF PERFORMANCE. CITY 1.,A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER e') T t %fir Z`Y -D y2_
WITH PROPER MAINTENANCE ANI? CAREFUL USE OF I LEGA VESCR(PTg9T� -
WATERR IT CAN GIVE MANY YEARS OF TROUBLE FREE SER- 1 / St �% �,-r �r'
.E. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED !SOIL
/
. FLING EXCESSIVE AMOUNT OF PAPER, CLOTH ICOMMENTS - r.-1I �,;✓Gj " T bp1' I
_'C .MATERIALS SOWN HE DRAIN, OR BY S;._ • r-1 FIELD�t
rTS OF WATER FROM LEAKY FAUCETS OR !NO. O`er IO' f'f I ��✓� II SIZE 3 X /3 C
DEPTH TO MONTH I9
TANK ITSELF SHOULD 3E CLEANED EVERY %`CATER TSABLE OF YEAR ��r�< J�Z
•_.. .TARS DEPENDING O. THE HABITS OF THE 'INSTALLER 77 L
=R OF FIXTURES THE HOUSE, AND r 1 C % ---11.CI�rr`p gV/� _ ,
-- =,GARBAGE D(S' SAL IS USED. CLEAN- 'SIZE !I
SEPTIC TANK {S) 7/�/ S
.- ... T TIME WILL AVOID HE RISK OF INJUR- ; `�-�
.:
DESTROYING THE DRAINF( LD DUE TO SOLIDS DRAINFIELD /8 0 FEET
OVER INTO THE DRA FIELD. CALL THE LENGTH 1
-PJNTY HEALTH DEPARTM NT FOR A LIST OF TRENC H AREA 39 G? SQ. FT.
..:PTIC TANK CLEANERS I YOUR AREA. THE
4N SERVE YOU BEST IF Y U SHOW HIM THIS DEPTH j_+r L2 CORRUGATED Olp
. .; L. WHEN HE COMES. ' K� ! CEMENT
ROCKp - �
HEAVY TRUCKS OR EQUIPMENT HOULD NEVER BE E 71 g:�OVt• Ili TOTAL
DRIVE OVER THE TANK OR DRAINFI LD. CONSULT THIS ;CU. YDS. t _ ? DEPTH:
RECOR iN CASE OF ANY BUILDI OS, DRIVEWAYS, 'RPACE 2ESERVED FOR
REEP•LACEMENT DISTRIBUTION FIELD: S .
SQ. FT'.
SWIM LNG POOLS, OR EXTENSIVE G ADING OR FILLING : -----
R'c R CONTEMPLATED. ! ^�, NORTH
SHR BS OR TREES SHOULD NOT BE PLANTED CLOSE TO Pi v 0 ' , '�O
. PTIC TANK AS THEY WOOL INTERFERE WITH (
.FAN. 'G OF THE TANK. THEY CAN PE PLANTED IN THE f '1, ��U /�
' AREA PROVIDING WILL° S ARE NOT USED. 1 1 2J�-2j�n`v E.' V�r
• A.DE iN THE DISPOSAL AREA SHOULD BE ( •
.j%f �/�
R=:=..`'..E WATER IS NOT POCKETED ON THE ! " • 4C� -••--�s /
•
r.'\,.`.' SETTING OF THE ROUND OVER THE I a r '>
1 . ..-.C„L�. BE `:LLED IN WIT SOIL. DO NOT EX- t 3�' ijD ? �' ✓r�l
THE LAWN IN -HE!DRi;;!�FIED AREA. -�`��_ A. €' ,
=T _�N FROM THE DRAINFIELD IS ABOUT
Ct4y 1).
. 'NCI CF RAIN PER DAY. ( \ {L'� AI \
RA.INAGE, DOWNSPOUTS AND WATER \
RECHARGE WATER SHOULD NOT 3E CON- •1\i "�
THE SEPTIC 5"STEMOR DISCHARGED INTO THE A�pRy 0, 31s' �u
AREA. 1 II .(�`
._ ,;r BACTERIA NEEDED IN A SEPTIC TANK ARE 1 J € 4
iND (N SEWAGE. THERE IS NO NEED TO ADD UN 28 20 3 I
• R OTHER STARTERS TO A SYSTEM. THE USE 01480 CPUNry Em.
-;'.ENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK ROH,t+E TALHEALTH �' {HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY BE RET + ',, r
HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR BY I
CHANGING THE CHARACTERISTICS OF THE SOIL. THE \ . 4 .' `
"C.^<.M LOSE OF BOWL CLEANERS OR CLEANING COM •
-
POUND WILL NOT KILL THE BACTERIAL ACTION OR SLOW I _ SOUTH r .
DOWN IT HEOPERATION OF THE SEPTIC TANK.
THIS IS AN IMPORTANT DOCUMENT DA.-E ! ' Soft A LIRE OF INSTALLER
�'P '1* 4a#ir'DEE&-Qr2 3TKE12 'i t• 7
E\TIAL PAPERS NATURE. I
• SiuNA',ilR=_OF INSPECTOR
-- I .
0 '/�
:dA.1=.1.viinKW'87x'n ON1IZ�N :-,f, __ - j.
,'SI-ir£:G96,.i1u'.0 rvivc'ex M:.l"�+ I - s t
� iJV•J cave.i oZ,
9NI833N19N3 511oOx3 a b45-831310 n '
t5 it .. . u� I � rj
ZJ' W ` GoC
'' z nV
ri
cc.
- per..- / sm $- ;i, C Cr' z
n C I ¢W v. .G dry 1 N O. J E -,
0 .co w' .J m 0 '.:Y: 1( a u' n
a Z ,Ill '.l
W �•
NLLu: Cs- c-
v Q 2 i
; O . tiu tip
OLai=- aC: — to ly
H&
— . [
> =
a
sr
= m N
W F N
F
ce- - -.....
tom 3 / g \\
e-
o \
/ *
\-i1 g' / h/% \
N Eoo N / as
a
.� J.. e \
0tooyt
1
An S
dN Y A N 1d N
�� °.) � I
to e �ft � S3 Z
og
�d
W vs y'o.@ W oO ' / L- `-
a'm t / In -
H � rVc \ p 7 /
le''
Y V N
t is N O N T \ 4.4 /
C s 3 \ ` /
V
uyz qz� •�\ ` , I
4
YG \
-/+.LI I p r2 \ G
- t.
;K N
K
Iiiii If az
g
— 1
1
p _ `` I 1
a0 I / 1 +
\ i , E r1:::7 ..-:. ' 1,1
I / / / N O/ / U•/ / m 0 n N /
/ / / / Z 0 a1�!
, , /' K
q
• / ` • -/+.IQ£ \