HomeMy WebLinkAboutSWG2023-00146 - SWG As-Built - 8/31/2023 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION QS,-
Permit Number SWG ZOa-3 -6015/6 Assessor Parcel # ya3O?- 34-90//0
Applicant Name 5ryX f?eriY Subdivision (Name/Div/Block/Lot)
Applicant Address P D Bog et51 /t c .JG F
5 35b c-(TR,/a-4 Sc.),
City, State, ff
f� Or-t- �. . RS` Installer Name finale aco.l irnS�a444
Zip 5 P
Site Address Designer Name A . I,i,/tc,/o
INSTALLATION CHECKLIST
In Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type ft11clll,4 7 h,2 . 1. Pretreatment Type
>5 ft.from foundation? - - ❑ N/A QJ YES ❑ NO
>50 ft. from wells? - 0 ❑ 0
>50 ft_from surface water? - - 0 0 0
Z ❑
HCleanout between building and tank? ❑ ❑
U Tank baffles present? El
VI P 24" access risers over each compartment?- - ❑ El ❑
0-
Ili
Effluent filter installed? - ❑ El ❑
Septic tank size ()-(36 gal Manufacturer 1perrh/,)✓
0 D-box water level and speed levelers used? - - ❑ N/A ®YES NO
0
DO Manifold/D-box accessible from surface? 0
mZ Check valves installed? - ❑ 0
OQ Li<< Schedule/Class 3.9S
2 Transport Line Size
Bedrooms installed (check one) iil 2 0 3 ❑4 ❑ 5 ❑6 0 Commercial/Other
>10 ft. from foundation?- - ❑ N/A ❑ YES 0 NO
>100 ft.from wells? 0 Z 0
W - ❑ ,❑ ❑
>100 ft. from surface water? - � ❑
i, >10 ft. from potable water lines?- ❑ ❑
— > 5 ft. from property lines and easements?- - ID
la ce > 30 ft.from downgradient curtain/foundation drains? - - ❑ 12 ❑
0 la ❑
Drainfield level and observation ports present 0
i! Graveless chambers or ❑ Clean gravel used? (check one) 0 0
Proper cover installed over drainfield?-
El
Pump tank setbacks consistant with septic tank? - - El N/A ❑
YES ❑ NO
Pump tank size gal Manufacturer
Z - ❑
< 24" access riser(s) and accessible from surface?- 0 ❑
I` Alarm or Control Panel Installed? -
a - ❑ ❑
2 Control Panel equipped with Timer/ ETM / Counter-
D
n- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
❑ Floats o ❑ Transducer
El" Pump Make/Model
a Tank draw down in/min Pump capacity gpm Sq Height ft
Pump off time Daily flow set at gpd
Pump on time Updated 121712015
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - [l YES
gl
If yes, please describe: NO
Were all components pumped out and properly abandoned per WAC246-272A-0300? - E] YES 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.
sec / 7-7-Ac1ED
PPROVE
AUG 3 1 2023 n
_
.
MASON COUNTY ENVIRONMENTAL i-Ic .rn
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Record Drawing Attached
CERTIFICATION OF INSTALLATION ,
INSTALLER DESIGNER/ ENGINEER
I certify that 1 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 a!!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 attached Record Drawing is accurate.
form and attach I-t cord Drawing is accurate.
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ignature f Installer Date -ir,.•;,..,,,r,t;.Fy+1
(4 \< �Q,Iltn,t dir.� � ` ss1
Printed Name of Signee •0c 5100325
.7,:: (HONV OVJEN DEtAIERD '�/
MASON COUNTY PUBLIC HEALTH c' ;(�N�+!'ti1� Sf � � t
The undersigned approves this Installation Report and tt"p io-cyr=Z°
Record ng on behalf of Mason County Public
Health:
Wdivu \ -31 -2-
Sig ture vi nmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8r21/2018
Brje-K Kell
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MASON COUNTY EN312023
RONMENTAL HEALTH