HomeMy WebLinkAboutSWG2022-00261 - SWG As-Built - 11/14/2023 1
OCT�2 7 2023
Mason County OSS Installation Report pg. 1 L REC N C UNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG Z02 .-0026/ Parcel # 322-31+3 (Se 1 SO
Applicant Name `Wo313 f V 104O L ANS''"'�� --,yr Subdivision (Name/Div/Block/Lot)
Applicant Address 66895g (ocret4 m 4. .rf.tow
City, State, Zip 13E4 LtVV- WA Installer Name 0:::54-4-pair,and 1C?-.q
Site Address 41 SZ if... St Rx (Q( Designer Name CineX4risLter Vlibe ex'l
INSTALLATION CHECKLIST
pull System Installation ❑Tank(s)Only ❑OOreai`nfielldOnlyy ❑Repair ❑Other
�`System Type e rutuiet 6.0 3 - zwlvgll-N s Pretreatment Type rer
>5 ft.from foundation? - M}rl iti At r+ri ii - El NIA YES ❑ NO
>50 ft.from wells? . �`'- - ❑ 13' 0
0 I1 0
_ >50 ft.from surface water? - �-
• Cleanout between building and tank? - ' 0 C3' 0
O Tank baffles present? - 0 IY ❑
a 24"access risers over each compartment/ .. 0 El 0
la Effluent filter installed? - ❑ a
Septic tank capacity(working) V.Z.SO gal Manufacturer 2.o '1
O D-box water level and speed levelers used? - R.WA 0 YES ❑ NO
oO Manifold/D-box accessible from surface?- 0 I2 ❑
u.
c i Check valves installed? . - ❑ 133" ❑
o4
f Transport Line Size lint Z Schedule/Class 504 4o
Bedrooms installed (check one) ❑ 2 1a ❑4 ❑5 ❑6 0 Commercial/Other
>10 ft.from foundation?- ❑ N/A [ Y, ES ❑ NO
(0 >100 ft.from wells? . ❑ 0
W >100 ft.from surface water? - 0 0., 0
it >10 ff.from potable water lines?- 0 - a ❑
aZ >5 ft.from property lines and easements?- ' 0 1r 0
C >30 ft.from downgradient curtain/foundation drains? . ❑ Di 0
0 Drainfield level and observation ports present ❑ 0 ❑
Di Graveless chambers or 5 Clean gravel used? (check one)
Proper cover installed over drainfield? 0 ❑❑� 0
Pump tank setbacks consistent with septic tank?- ❑ NIA Ltd YES 0 No
• Pump tank capacity(flood) Irt3O gal Manufacturer $.'Wr4Rt'-AA-e2
F24"access rlser(s)and accessible from surface?- ❑ Er
n. Alarm or Control Panel Installed? - 0 0 0
f Control Panel equipped ith Timer/ETM/Counter- 0 E 0
7
4 Pump installed in Bucket or ❑ On Block or 0 Other
O. Pump Make/Model 1-1i3e41. ti -2.4S0 ❑ Floats or NKansducer
2
Tank draw down U•S in/min Pump capacity 1� gpm Squirt Height S ft
a Pump on time 2% 5 O Pump off time 1 l--1 2
r SO Daily flow set at faD qpd
updated ea112a18
Mason County O55 Installation Report pg. 2 Parcel# a '?) 1 i % k C)
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? D YES
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? YES ❑ NO
RECORD DRAWING
This 1s a permanent record and must be accent.and dpcdptive enough to relocate In the need of maintenance.ctMltle.and Mere devaiopnent Typical Read
Drawings contain: DralnfiSd a mnvW orientation a Hyatt.Septic/pump lank mcadm.North arrow.mane danger,existing and proposed buildings.Marion of weds.waumnes.
walls.observatm ports.&tomtits,end other matpance access points. Incomplete Reoo DrawMgs may create additional delays In Anal installation approval and tamed permits.
ecord 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 all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certi hat all information contained on this I further certify that all information contained on this
form and ached Record Drawing is accurate. form and attached Record Drawing is accurate.
Signatu of Installer Da e r
O
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH /"
The undersigned approves this Installation Report and ur.e`e uma,
Record Drawing on behalf of Mason County Public Z3
Health: I D/I (2
( (l`'G(Z3 / o/ 3
Signature of Environmental ealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE aoausd 81211206
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