HomeMy WebLinkAboutSWG2020-00350 - SWG As-Built - 6/30/2023 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 20 ZQ- 00 3 C-l_ Parcel# 1-Z5 p
Applicant Name St 0-7—Pr _ Subdivision (Name/Div/Block/Lot)
Applicant Address YR/o ' fiasDI clE• N v1/ £I3$
City. State. Zip W R$/S- Installer Name bi
^ x,,-_ L r''-y
Site Address
111 t c�cki 1'i-c-- D iL__-_.-Designer Name __ , q,�- s-� t ,- ""1-1-1
/- INSTALLATION CHECKLIST
Full System instal;atior. lank st
( )Only ❑ Drainfieid Oniy 0 Repair
0 t7tner
System Type Pretreatment Type
>5 ft from foundation'? • - -. - _
>50 ft. from wells? - - .- ❑ NIA Li NO
nn Lrr ''''..t--.-7
>50 ft.from surface water? . - •. - -. - .. Y_ _. .. lt V L -
- ❑ ❑
µ Cleancut between building and tank? - - _ - - ❑ �-1
pow -�zo3 ❑ � ❑
U Tank baffles presents
❑
24"access risers over each compartme �/ ❑
LU Effluent filter installed?- •• ------ 0
to - ❑
Septic tank size , `��' gal Manufacturer r f•I ❑
1 a 0-box water level and speed levelers used? - - - -. - - - -- - - -- - - - _ _
o Manifold/D-bcx accessible from surface?- ❑ NrA El Yet, NO
E Check valves installed? . _ .. _ _ _ ❑ 0
U Ell
L1
x Transport Line Size Schedule/Class._. __
Bedrooms installed (check one) 0 2 f8;13 0 4 (0 5 ❑s ❑Commercial/Othej
}'10 ft. from foundation? . ._ - .• _ -- ._ -• _ .- _ .. _ .. . _ _ - ❑ N/A a s r r NO
0 >100f..from wells?• _
W >10o ft.from surface water? • - -• _ •. ❑ ❑' 0
0
Li Z >10 ft. from potable water lines?• _
� 5f•.f property
d romlines and easements
0 >• 30 ft. from downgradien;curtain/foundation drains?- •. -• -• - - -. - - 0 �• �� 0
C t D
Drafreld level and observation ports present - - - - -- - - •- - -. - - - - 0 0 0
•
Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- -- -- -• - - - .. - .- _ .. _ .. _ _ - - ❑ u ❑
Pump tank setbacks consistent with septic tank? • - •- - _ _.. _ _� _ ❑ N/A
- �YGS ❑ NO
ZPump tank size !fit-% gal Manufacturer /-�'1 c.:L--K-:`14:•
d 24"access nser(s) and accessible from surface?- -. - - - - -. .- .- - -. - 0 l /
a. Alarm or Control Panel Installed? - - - - -- - - -- _ _ _ .- ._ - - - - ❑ IILJJJI
❑ E% 00
j Control Panel equipped w Timer/ETM I Counter• _ . ❑
a Pump installed in bucket or
❑ On Block or ❑ Other
O. Pun p Make/Mode) c-;� -l'•• %� 2 cjG
E-Floats or ❑ Transducer
R Tank draw down
cL _ 3 in/min Pump capacity 6--G/
�gpm Squirt Height S ft
Pump on time -I i Sc'r. Pump off time_ 3 h r Daily flow set at 30
C9�.1e Cuclr, r 5- gpd
Olwa u i fi:'::U.B
run 1,'07e r 5'. f 0 r--) _•__.- A-7,-/
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -
If yes, please describe: ❑ YES
Were all components pumped out and properly abandoned per WAC246-272A-0300?
- 0 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: grainfield 8 manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainrield,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
1 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
l further certify that all information contained on this
I further certify that all information contained on this
f d attac ed R cord D awing is accurate. form and attached Record Drawing is accurate.
��h�-Z 3 t
Signature f Installer Date
.>
Printed me of Signee •,•Cc\
Na'
MASON COUNTY PUBLIC HEALTH s� � y° *.Cr,
The undersigned approves this Installation Report and ...-' t'�
Record Drawing on behalf of Mason County Public �
Health: ......RI,Dfe„ .,,., r,.._..
� ^A �5�Li_�Lt�
Oc-7 NaprViei
br&Dta Expire::j l-1-6 -?- '
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
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