HomeMy WebLinkAboutSWG2020-00208 - SWG As-Built - 9/11/2023 •
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SVVG 2.020- 0O 2-0 Parcel# 4. Z L. 0 3 V 9 p az 0
Applicant Name DM/A.) 0GG Subdivision (Name/Div/Block/Lot)
Applicant Address /0 bey 63C
City, State, Zip /7coo S/e;R- 9 0- 9% f ---?) Installer Name ',N �;% O' ,tr- 4
Site Address ar.L f,,1,ZA, ,�.4r,L, ,,,,, (e-$I- Designer Name /`free-44 g 1, s'sii /74/✓«,d . .
INSTALLATION CHECKLIST
U Futi System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type P(LSsvr:„ .,.--,-( . Pretreatment Type /Ja,..)�
>5 ft from foundation? - `L`, Z - ❑wA
0 YES ❑ NO
>50 ft from wells? - --, - ----- ❑ El ElZ >50 ft from surface water? --- --�� ____ ___ 0 o
Ea
HCleanout between building and tank? .•-- ---- 0 0
0 Tank baffles present? - - ❑ 1 ❑
i 24'access risers over each compartment?- --- - 0 ❑
W Effluent fitter installed?- 'V'' /✓-
co
❑ P El-
Septic tank size /2.5o gal Manufacturer / GF.E/-A,, p/* T
o D-box water level and speed levelers used?
�-� - 0 N/A ❑YES 0 NO
DO Manifold/D-box accessible from surface?- N--
4A ❑ ❑
InZ Check valves installed? - ❑ ❑ ❑
O<
2 Transport Line Size Schedule/Class
Bedrooms installed(check one) ❑ Ep pit 0:it . I I . ❑CommercialOther -eve P/F /� _EG
>10 ft from foundation?- � <
❑ N/A ELYES ❑ NO
ea >100 ft.from wells?- --SEP.1 1-2023--- ;,.;., ❑ El- 0
--I >100 ft from surface water? -
W MASON COUNTY ENVIRONMENTAL HEAT- 0 ❑ti >10 ft from potable water lines?- 0
Z▪ >5ftfrom propertyJBWI
lines and easements?- - ❑ ❑
>30 ft from downgradient curtain/foundation drains?- - ❑
Drainfield level and observation ports present - - - ❑
El Graveless chambers or Clean gravel used? (check one) ❑ El
Proper cover installed over drainfreld?- - ❑ lEi 0
Pump tank setbacks consistant with septic tank?- - ❑ WA IYES 0 NO
Pump tank size I 7-So gal Manufacturer i//4-G!'i it''r.-ni F ie.:: 'w-
z
• 24"access riser(s)and accessible from surface?-
f-- Alarm or Control Panel Installed? - ElEl
Control Panel equipped with Timer/ETM/Counter- - ❑ W ❑
CI- Pump installed in ❑ Bucket or OOn Block or
El Other
a. Pump Make/Model 2O/'t C. ,� /J€
, Floats or El Transducer
a Tank draw down ! 1 Z S in/min Pump capacity 3 3 gpm Squirt Height 1/Z— ft
Pump on time /.t IL Pump off time !.( Daily flow set at 7-7 0
Mason County OSS Installation Report pg. 2 Paroal# Z/C 3 9/9 6 2Z o
ABANDONMENT RECORAD
Were existing septic components abandoned as pert of this - - El YES El NO
If yes, please describe:
Were all components pumped out and properly abandoned per WA 46-272A-0300? - - 0 YES 0 NO
RECORD DRAWING
This is a permanent record aid oust be accurate and descriptive enough to re-locale in the need of niaideoanoe activities and future development Typical Record
Drawings contain: Drainfeid&manfoid orientation&layout.Sepidpunp tank location,Norm arrow,reserve dranfield,existing and proposed bulkigs,location of wells,waterirres,
wets,observaion ports,deanouts,and other maintenance access points. kicamplete Record Drawings may create additional delays in final installation approval and related permts.
APPROVE
SEP 1 1 2023
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
,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 a ed Record Drawing is accurate. form and attached Record Drawing is accurate.
- of Installer Date
(� L . 42///4.4- \� '��,
Printed Name of�igrree1+
5 IS
MASON COUNTY PUBLIC HEALTH 1"&,44" s `4
/�, w`� "_.`,:
The undersigned approves this Installation Report and ' %,1
Record Drawing on behalf of Mason County Public j os, 510c , °'
Hea rr i orRSowTHAN..L.Hsivs.isms
bi
A LtCEP D DESIGNER
of
CI' ,225F r :.nvt: 4
gri signer, , ��, , : ': Health Specialist Date _
(stamp, signature and date)
'MS FORM MAY BE SCANNED AND AU4LLABLE FOR PUBLIC VIEW ON THE MASON COUNTY YHEB sirE UPdeled mil"
RECORD DRAWING(continued)
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Site Plan For Darin & Lisa Ogg
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