HomeMy WebLinkAboutSWG2018-00450 - SWG As-Built - 9/20/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2Q/8 — C O'-/ 6 Parcel# -31.1.0 S769 0/22
Applicant Name J`CL7-T C5 us vcci clei Subdivision (Name/Div/Block/Lot)
PP
A licantAddress E.E. U(,t,eoy�e\ �r 4- o& P/? 7 17611Pfi4-S�/2v-
City, State, Zip ( t t"niiv. (.0 G. cjJ sc 7 Installer Name i
Site Address 5Gc I,,4 Designer Name w`t
INSTALLATION CHECKLIST
IcYfull System Installation El Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type 6yovtt—/ Pretreatment Type
>5 ft. from foundation? - _ EKES- ❑ N/A E s 0 NO
>50 ft. from wells? - U T -- - -1� ❑
Z >50 ft. from surface water? - S E P 13 2023 ElE El
FQ- Cleanout between building and tank? - - - - ❑ �,/ El
U Tank baffles present? - - Elu ❑
P 24" access risers over each compartment? k3-Y — ❑ ❑ Iff
a
W Effluent filter installed?- - ❑ IRV ❑
co
Septic tank capacity(working) / 2-00 gal Manufacturer 1 r-ci4 er
0 D-box water level and speed levelers used? - - [II N/A EES El NO
J r-�/
D0 Manifold/D-box accessible from surface?- - ElL�7 ❑
mZ Check valves installed? - - ❑ ❑ 12---
OQ „ Schedule/Class �G
2 Transport Line Size
Bedrooms installed (check one) ❑ 2 El 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO
0 >100 ft. from wells?- - ❑ �,/ ❑
-1 >100 ft. from surface water? - - ❑ Ld ❑
W LL ❑>10 ft. from potable water lines?- - ❑
> 5 ft. from property lines and easements?- - ❑ re ❑
> 30 ft. from downgradient curtain/foundation drains?- ❑,/ LJ ❑
0
Drainfield level and observation ports present - - Ltd' ❑ El
E/6raveless chambers or ❑ Clean gravel used? (check one) �,/
Proper cover installed over drainfield?- - El 1-2 El
Pump tank setbacks consistent with septic tank?- - ❑ N/A El YES El NO
Pump tank capacity (flood) gal Manufacturer
Z
< 24" access riser(s) and accessible from surface? ❑ ❑ El
F- Alarm or Control Panel Installed? - - ❑ ID
a Control Panel equipped with Timer/ ETM/Counter- -
El ❑ ❑
d rit or ❑ On Block or ❑ Other
m umpMe Milt El Floats or El Transducer
a. Tank gtarip�` 023 capacity in/min Pumpgpm Squirt Height ft
Pump off time Daily flow set at gpd
Pump on time MASON CGUI171'tNVIKJN,%LNTAL HEALTE' uFdated8/21l20?8
NA
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES ❑ NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES D 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.
S'e/ 71/167(sed
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
4 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 -nd attached Re, . • Drawing is accurate. form and attached Record Drawing is accurate.
Signature of Installer ,sejefi Date
sue - fit. fr-CK-1 '5 ?‘\‘'
Printed Name of Signee (\ �
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public Ff -)
Health:
g/7a
Sign ure of Environmental Health Specialist Datecf ` ��23 (stamp, signature and date)
"!r .1 Updated 8/21I2018
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC vt0/1'p�I-TE MASON COUNTY WEB SITE
0.0 HLL HEALTH
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