HomeMy WebLinkAboutSWG2020-00468 - SWG As-Built - 8/21/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2.02.b-ooc-f US Parcel # 97:2_I2S I 1 021 1
Applicant Name \1I<�-\- —\oNykL-D _ Subdivision (Name/Div/Block/Lot)
Applicant Address 333 k 5 NEST 2- ,e__
City, State, Zip TvLS e,N1 , p 2S13c- Installer Name TESS 1•- -`r
Site Address `.-o t .) L tQ-t-E3 Q.C- Designer Name ,eDiekvA N\)NTH
INSTALLATION CHECKLIST
[<F II System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type PrzE5Su'ZE `P2ENCA1 )) Ft.o')T Pretreatment Type rJ j Pt
>5 ft. from foundation? - ❑ N/A [`' YES ❑ NO
>50 ft.from wells? - .- ❑ ❑
Z >50 ft. from surface water? - - 0 0
< Cleanout between building and tank? - - 0 ,�,/ 0
U Tank baffles present? - - ❑ L3 0
H 24" access risers over each compartment?- - ❑ (r ❑
W Effluent filter installed?- .- ❑ Er ❑
to
Septic tank size 1200 gal Manufacturer -,0<..) 1vU QLYk-Lt=►WENT
❑ D-box water level and speed levelers used? - - N/A ❑ YES ❑ NO
-1QO Manifold/D-box accessible from surface?. - ID 13— 0
u.
o0Z Check valves installed? - - ❑ Et' ❑
❑Q
2 Transport Line Size I ' /t-1 Schedule/Class Z-.ba
Bedrooms installed (check one) E 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation? - - ❑ N/A l'YES ❑ NO
O >100 ft.from wells?- ❑ El' ❑
--1 >100 ft.from surface water? - I Q JJ-U- ❑ [r ❑
ti >10 ft.from potable water lines?- i -- r ❑ ❑
Z > 5 ft. from property lines and easements?I ORS -- �) ❑ El- ❑
t2 > 30 ft.from downgradient curtain/foundati og drains?- -.1 0 Er ❑
Q Drainfield level and observation ports pres- - - �- - ❑ [r ❑
E Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ Er ❑
Pump tank setbacks conaistant with septic tank? - -- ❑ NIA Qire3 0 no
• Pump tank size I SS FLouT' gal Manufacturer I LOVJ1K - I NPILTY2Yr1"d'2
< 24" access riser(s) and accessible from surface?- - ❑ El-- ❑
F-
a Alarm or Control Panel Installed? - - Er ❑ El
2 Control Panel equipped with Timer/ETM/Counter- - a- ❑ ❑
D
- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 1, )1A
tl Pump Make/Model t.�)to ❑ Floats VI- El Transducer
a. Tank draw down N 11A in/min Pump capacity tno t-n\t- gpm Squirt Heigh ' y i,., •-ft�
a
Pump on time N(W Pump off time iLi1 Daily flow set at -` I O gpd
u,da,ed8/211 cih
Mason Cc;u;tv_ OSS I tallation Report pg. 2 Parcel# `/7--21 25 ! 1 b2-11
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES fJ I in ErNO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES tJf IA [MVO
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,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
PPROVED
MASON CCUA. 2023
YENVlIICNMENTAL HEACT-
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
r 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
& ofInstalr
attached cord Dra ing is accurate. form and attached Record Drawing is accurate.
(1 ----- It' ll 'l- \
,:rx'9,N
Date sfi ' %'. % r .ft
5e l t, -1 t ‘,1 ,F3
(-:•••�t
�`T '��' .' It
Printed Name of Signee ✓ `+
7.1
MASON COUNTY PUBLIC HEALTH ! '. •t
%The undersigned approves this Installation Report and •``
Record Drawing on behalf of Mason County Public ;,' • q r ...
t .. ,. ,
He ,1:, t, ltt It '' ` %
I=hinitca �U'
atuVS
- 'nvironmental Heal h 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
CHARLES PL
too.
0 w -a 0
m D C M m
O O71 0 -I
cn C
0
Trl —I < m m
-i Z y
z m c o
D cn c Z
_ '
O K
r
- r.) Z
z 0 /
O —Im o o
\•------
co m
oo-
z
w
r-
r
m
7J
iT
r
OC
zN
DZ rn
F'1!:
a F
KCm
/� Z N
M/ C F
i � m N C o
m m /
' _ 11:2 / j / / ^
i
D /7 7/ �� I
cn
/ /� / / C.)o /, / /
7 7 V / �V / m
O
/ Co
/ ND II
No 13
__-.. —1 O
—7(7'
J
ZD ye/ •+;.
•O T Cu.m ‘ "'i 4 •I•4!
tzO Z$
ei N O D D O .44
°
N m ( w al-I Z n iv
V
N 0 y-j
_ G r N
K Ro ca
D a
a coC4
0C4
--.10
p
v, , `^ 2 O
-� Z m -I O Z
xz r- D D p -I
PCP
O o O P C) D
D Z 0 0 m r)
m m o D g
w _ ,,, m
°
D to D
o m r- D
ro No l/) m -1
o j -0G) 0
o r- D o Z
O I- N
A
0/
CO