HomeMy WebLinkAboutSWG2023-00272 - SWG As-Built - 10/23/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION I
Permit Number SWG" 2C2-3— 0OZ72— Parcel r ! Z) (G -- S.-1- OO I 1 0
Applicant Name &A ( 4l.)N Subdivision (Name/Div/Block/Lot) , _
ApplicantAddress/U 0 /0 I(-r rr7ena A/ (� /
a1 iry 14 Installer Name /7 / -Vl L if* t
City. State.Zip /C/s soyn ✓f r r/Bncti c.,,y
Site Address 9GHe- Designer Name /Ai r /1.4.1.4e
INSTALLATION CHECKLIST
1 System Installation 0 Tank(s))Only 0 Grainfield Orgy 0 Repair ❑Other
- System Type loli.dex+r1/4. Pretreatment Type --
>5 ft from foundation? - 1 - ❑cap arEa 0 NO
>50 ft from wells? - - ❑ -ill- 0
Z >50 ft from surface water? - t- 0 �' 0
et Cleanout between building and tank? .:_pt.1(12a---L- 0 EP 0
a Tank baffles present? - it( - El43+ 0
a24°access risers over each compartment? - ❑ `® 0
UI Efiluentfitterinstalled?- • - 0 - 0
te
Septic tank size /in) gal Manufacturer_ /1,46/C1/r'rAAJ
0 D-box water level and speed levelers used?e. - �artA ❑vita ❑ NO
p0 Manitdd/D-box accessible from surface?- b - 0
9 VC/ PP Check valves installed? - 0 a 0
Z Transport Line Size I Schedule/Class SChol T v Y'
Bedrooms installed(check one) .k2 ❑3 ❑4 ❑ 5 ❑S ❑CommerciauOther
>10 ft from foundation? - n wA Free ❑ No
a >100ftfromwalls?- g.£mil. 0
W >100ft from surface water?- - Elea 0
it. >10 ft from potable water lines? - 0 F7 0
a >5 ft from property lines and easements?- - 0 la ❑
Q >30 ft from downgradient curtain/foundation on drains?- - 0
Grainfield level and observation pals present - - 0 0
❑ Graveless chambers or S Clean gravel used? (check one)
Proper cover installed over drainfield? 0 la 0
Pump tank setbacks consistent with septic tank?- El WA
,,' ti tins 0 NO
Y Pump tank size ( SOD gal Manufacturer QM 14a\ 1 n
4 24'access riser(s)and accessible from surface? 0 Or 0
I-
a. Alarm or Control Panel Installed? - 0 -V ❑
M Control Panel equipped with Timer/ETM I Counter - 0 fill El
a Pump Stalled in ❑ Bucket or-fran Block for 0 Other
Pump Make/Model 0.
_t lr e -rt. .1 ❑ Floats or ssIFTransducer
W. Tank draw down 5,— in/min Pump capacity 31 qpm Squirt Height R
Pump on time I C„LL Pump off time ( "zi , 2-101.ez, Gaily flow set at r d gpd
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Mason County OSS Installation Report pg. 2 Parcels Cf it 1 (c —S z— Cc/ 10
ABANDONMENT RECORD
Were existing septic components ap/a/tiod as part/of 1/�ii Project? - _No
II yes, please describe: /1€ ✓3iJ NL/6/,.c +I4A✓it
Were al components pumped out and properly abandoned per WAC246-272A-0300? - 132154 0 No
RECORD DRAWING
TW b a M.®aan most ad most be me ad deay4n e.cax b se-loc. S e awed of raidolaseoct asrl.bs M lien dn.n.opo at "MS Record
oaten caralrt a..Yaaas aeaxdaeaaa.S Semi s.prdpnp tank Ionia Nan.arras.enneJ*AaN.alias and sweet bake.location aweb.welaInes.
welt obessacn part.aaaa4 end other mainkearce access wis taros Record D.Mp may meta adios.delays in sal isNWew spa..,ad visaed permit
5"Ae ct 5 LA-e
• ❑ 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
here have been cleared/approved by both the designer shown here have been cleated/approved by both
and Mason County Public Health and meet all State myself and Meson County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further ce••••• that all information contained on this I further certify that all inhumation contained on this
form a • form• Drawing is accurate. fo and attached Record Drawing is accurate
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e—Pli/, / 9 4€/!, 1 III9/7/23
Printed Name of r x,.,.
I. Z ?.
MASON COUNTY PUBLIC HEALTH - -^gym
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public e ,• .�
Health: 2 :,�h
cK- `6Yi (6 ,-z-3 /Z
Signature of Health Specialist Dale d4
(stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY wEB SITE urdad emrnae
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