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Home My WebLink AboutSWG2023-00302 - SWG As-Built - 9/11/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG2er2.3-00304 Parcel #?Z71 1 9-0003u Applicant Name FlegGy, DovlovaA Subdivision (Name/Div/Block/Lot) Applicant Address po k2())( 33 SUX Set QEG2&h *2 City, State, Zip ttoop16I,m, va igsc..15 Installer Name Naples EXCA VAliol Site Address 11 2S11 F ,S-ta-K, Igt 1 O(v Designer Name INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair [ Other f isnp p),94) System Type Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑YES ❑ NO >50 ft. from wells? - - ❑ ❑ ❑ Z >50 ft. from surface water? - - ❑ ❑ ❑ FQ- Cleanout between building and tank? - - ❑ ❑ ❑ U Tank baffles present? - - ❑ ❑ ❑ d El access risers over each compartment?- - ❑ ❑ LI] Effluent filter installed?- - ❑ ❑ ❑ N Septic tank size gal Manufacturer D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO 0 0 Manifold/D-box accessible from surface?- - ❑ ❑ ❑ CO, Z Check valves installed? - - ❑ ❑ ❑ ❑Q E Transport Line Size Schedule/Class Bedrooms installed (check one) Er2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO ❑ >100 ft. from wells?- - ❑ ❑ ❑ W >100 ft. from surface water? - - ❑ II ii >10 ft. from potable water lines?- - ❑ ❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑ ❑ Q cc > 30 ft. from downgradient curtain/foundation drains?- . ❑ ❑ ❑ • 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 R"YES ❑ NO • Pump tank size gal Manufacturer 10t[[' < 24" access riser(s) and accessible from surface?- - ❑ NJ. ❑ d Alarm or Control Panel Installed? - - ❑ L' ❑ CID - ------------:"------ 0 • Control Panel equipped with Timer/ETM/Counter [� ❑ D n- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other CL Pump Make/Model 7J)Q,{ ,,lex V Z(y "Floats or ❑ Transducer c.) a Tank draw down in/min Pump capacity gpm Squirt Height ti Pump on time Pump off time Daily flow set at qpd w 1� Updated,. 2018 r1 ��71 Mason County OSS Installation Report pg. 2 Parcel# 2€2?IC - sal - o003O ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - d YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - BYES 0 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,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. It" � p1 E SEP 1 "" NVIRO�01A1-HEA��H MASON c°�Nl�.00 dRecord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that l 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 S�'1G1,1'l� teg le( Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public a h: L\,,�fi fi-14\ c I-2:1) Si at f nvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21i2018 RECORD DRAWING (continued) Houu. 9 Co Oio N A.; N e,'), LARGE i(St {;•c41 _ - - - - ) Jew Zoc 1rrPµmP 4 '. y H M go m 4 P p b „ tiotAcK, is-- , Psi V ill Lc) M' lif ce OA''co rY�N 1 12023 c`a IRp414 , f'd jell/ "I'll y6,4LTh ?- E Sfi atti RoOIt 1 eUV