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HomeMy WebLinkAboutSWG2023-00229 - SWG As-Built - 8/15/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-0OZZ'l Parcel# 2 Z o I$ -51 - 001 12 Applicant Name Robert tLd Subdivision (Name/Div/Block/Lot) Applicant Address 50 E sInoair pi. -Irian X U 4-.3 OF 112-r `/13 in+ (a+ Ill City, State, Zip she l- vn, WA 9858L1 Installer Name v1'tple ' EX(01 v% ' 14 Site Address 50 E $lt'1Glair PI- Designer Name i C ( j l kWAUGINSTALLATION CHECKLIST IAUG0 4 7 >3 /� 1 J CI Full System Installation ❑Tank(s)Only ❑ Drainfield Only ID Repair 5'Other�tlf-t- Sta-ho System Type 61ra(Vt Pretreatment Type ; Pu' >5 ft. from foundation? - - ❑ N/A ❑YES ❑ NO >50 ft. from wells? - - ❑ ❑ ❑ Z• >50 ft. from surface water? - - ❑ ❑ ❑ 1-- Cleanout between building and tank? - - ❑ ❑ ❑ U Tank baffles present? - -;- - ❑ ❑ ❑ a24" access risers over each compartment?- - ❑ ❑ ❑ W Effluent filter installed?- - ❑ ❑ ❑ N Septic tank size gal Manufacturer ❑ D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO XJ O Manifold/D-box accessible from surface?- - ❑ ❑ ❑ u. mZ Check valves installed? - - ❑ ❑ ❑ ❑Q 2 Transport Line Size Schedule/Class Bedrooms installed (check one) [i 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ NIA ❑ YES ❑ NO ❑ >100 ft. from wells? - - ❑ ❑ ❑ W >100 ft. from surface water? - - ❑ ❑ ❑ u >10 ft. from potable water lines?- - ❑ ❑ ❑ Z > 5 ft.from property lines and easements?- - ❑ III Q ❑ ❑ ❑ � > 30 ft. from downgradient curtain/foundation drains?- - o Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A [ YES ❑ NO • Pump tank size gal Manufacturer Z001 a < 24" access riser(s) and accessible from surface?- - ❑ Et ❑ F- Alarm or Control Panel Installed? - - ❑ IR ❑ a gJ ❑ ❑ 2 Control Panel equipped with Timer/ETM /Counter- - D a. Pump installed in ❑ Bucket�orr dOn Block or ❑ Other C- Pump Make/Model IOQJ t-ex li4 dFloats or ❑ Transducer Q. Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 821/2018 V .1 Mason County OSS Installation Report pg. 2 Parcel # 2261g-61- OBi 17i ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES [A NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - E YES li 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. A . F10vir •z,.., , . A , pub 15 ?023 'Y ENVIRnN IP 4/ MENTAL HEALTH L/ 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. Signature of Installer Date hane, Moes Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public He. • L.-- C-I5 2'-c Vv Sic nat. f 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 arz''rzota fah" RECORD DRAWING (continued) � o # • ch P p „ R 0 it ONCO04/71, �S?D?3 lRQ Ap• Jew y4.1(Ty