HomeMy WebLinkAboutSWG2021-00190 - SWG As-Built - 8/1/2023•
• Mason County OSS Installation Report P pg. 1 C',Q4, MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFO
NATION
Permit Number SWG 2/ ''0�2I— 00V�'d Parcel # N'2Zi4 - 21 ^cjay1Z.�.
Applicant Name i drib) � 1)64'iC4 Subdivision (Name/Div/Block/Lot)
Applicant Address 137 4 Lf 'e,+I, f l 14
City, State, Zip µverbs2 j ...r— 1 AP' 1 dS lnstalier Name C3" S (_ i
Site Address 5 Designer Name `!"'
INSTALLATION CHECKLIST
Full System Installation 0 Tank(s)Only 0 Drainfield Only 0 Repair 0 Other
1 System Type _ SIG —�T`L ldL. Pretreatment Type _
>5 ft. from foundation? - .no- ` adiAt _ _
>50 ft.from wells? N/A ❑YES ❑ NO
Y >50 ft.from surface water? - 0 0
Z 0 0
H Cleanout between building and tank? 0
❑
�,y Tank baffles present? ❑ 0
d24"access risers over each compartment"?- 0
Lu Effluent filter installed? ❑ 0
co
Septic tank capacity(working) I ) 0
A Y _.ga! Manufacturer JvU� 2.�qheitt- ,
O D-box water level and speed levelers urea? lid ❑
N/A ❑ YES • NO
XO Manifold/D-box accessible from surface?- - El ❑
u.
o.a Check valves installed? ii - ❑ �T,v 0
E Transport Line Size 2 Schedule/Class L O —
•
Bedrooms installed(check one) 0 2 '3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - - - - .' _-striazd4c - g N/A ❑ YES 0 NO
0 >100 ft. front wells?
--1 >100 ft. from surface water? - 0
0
2 W ❑❑ ❑
>10 ft. from potable water lines?- 0
.4el G
> 5 ft. from property lines and easements?- - 0
0 > 30 ft.from downgradient curtain/foundation drains?- - 0 0
Drainfield level and observation ports present - - - -- i❑ 0
Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ Xr 0
Pump tank setbacks consistent with septic tank? 0 NIA ki YES ❑ NO
Z Pump tank capacity (flood) 12Cc? gal Manufacturer4. kAGi11e-44
< 24"access riser(s)and accessible from surface?- - - - •- . 0 0
• a. Alarm or Control Panel Installed? ❑ g ❑
2 nntr rat equipped with Timer 1 ET M/ Counter- - - -- - - -- - - - - 0 P520
Ish.PC)ft installed in 0 Bucket or tirOn Block or 0 Otner
P ake/Model -1 kr. t J `" I J Z 0 Transducer
Floats or
r p,, Tank draw dvw�M Tu .`t in/min Pump capacity_ _' `{�gpm Squirt Height S
g --- fi
Pumpon time I , �• S 4 :
...i,, •"w Pump off time _ Daily flow set at 'L1 gpd y
z
Mason County OSS Installation Report
pg. 2 Oarcel# /2/a-2 /y-Zl— VDU yZ
3 ABANDONMENT REC p RD ;
Were existing septic campcnanis abandoned as pan of this project? - •{ - - - - _ . . YES le NO y
If yes. please describe: •'i !
Were all components pumped out and properly abandoned per WAC246-272a-O300?f'- - -k-/f 0 YES *- i�
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 Rr.core
Drawings c:aaam Dranfield&n.anrtcld orieniation tt layou:.Scotia/pump Ia^6lacat;un.haal:arrom roacvc a:c,r t do. eiesGrM and proposed st:flaings.iacaIon o'malls waterlines
.uclls.a atc:vatinn ports Jennnets,ace otftor maintenance access points. Incomplete Ri:.;;xa Dra..i:.ga nviq rv;itc;r.l,:ti and dolays is Mal mstaflatuu;aptxtwal and nc4ate.1 permit,
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,..record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER ;
/certify that I installed the system in accordance with /certify that the system has been installed in accor-
the septic design stamped'APPROVED"by Mason dance with the septic design stamped"APPROVED"by
i 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
/further certify that all information contained on this /further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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314124022 12�Zz .�k1Of 1
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Signature of Installer Dah; 0 IA
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Printed Name ofSignee 1� 0 1 0
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MASON COUNTY PUBLIC HEALTH r„. , <�,1
I The undersigned approves this Installation Renort aA P p �' s DES DESIGNER
041 f`��Il`
1 Record Drawing on behalf of Mason County Public, ® CENSED DESIGNEi2 11
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Si nar. ,,of Environmental Health Specialist Date L,J,�, •
t ,,s4m1a. signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SiTE Unnx"a'2 v21•ttr
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i• L SEC:, EEM - `� ply
..� �� low. ��"...�� .r . 1. Proposed residence
LXpIHLS J�to, i.
2. Audio/visual alarm
~ . 3. 1200 gallon concrete septic tank
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4. 1200 gallon pump tank with two risers
5. Transport line
6. Valve Box
7. Primary/Reserve Drainfield/r9dr'"v`/"w
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0�,•, '� �.,r' ; 8. Clean out
r�,r,y 9. Waterline
' --- - - SL#1: 0-39" loam
39" + water restrictive
(�7 IV !y ,t.. ,.,. SL#2: 0-34 loam
34"+ water restrictive 4 it
1Y- l-- '.;+_y ._ SL#3: 0-38" loam
38"+ water restrictive
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202
Lateral# Length Length Orifice
# Distance from DistanetIrtmog Length#
-"tNVIPPn
# (Feet) (Inches) Spacing " Orifices feeder line of end of lateral
1.
2DJA At HE,
4at.ri.f
40 480, 48, 10 2
2 40. 480 48 10 2 2 40
3 40. 480. 48 10 2 2, 40
4. 40 480. 48 10 2 2 40
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5 40 480 48 10 2 40
Total 200. 50. 29.5 GPM
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