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HomeMy WebLinkAboutSWG2018-00165 - SWG As-Built - 4/13/2023 Mason County-OSS-inst&Iation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG WI`) - polbC Parcel# 2200,3 -SO - tea2Z_ Applicant Name R.cNggo 0424,. 4'0 Subdivision (Name/Div/BlockiLot) Applicant Address 6//T R/urpr.uro.rr t.s' //Aiz rsr€met Rerrrc,4-r 'tom City,State,Zip oay.24,44 . WKI l- 5U2+ Installer Name Ge NM//«a Co4'jr Site Address 30/ E. LaA cN. Designer Name CNAeis El ST.cO A' INSTALLATION CHECKLIST uli System Installation 0 Tank(s)Only ❑Orainfield Only ❑Repair ❑Other System Type Me uNO Pretreatment Type >5 ft.from foundation? - - ❑NIA in Yes ❑NO >50 ft.from wells? - '- ❑ ® ❑ 2• >50 ft.from surface water? - ❑ ® 0 F Cleanout between building and tank? CI CI 0 U Tank baffles present? 0 ® ❑ 6 El El access risers over each compartment?- ❑ W Effluent filter Installed?- ❑ © ❑ to Septic tank size /09171 gal Manufacturer Infiltrator O D-box water level and speed levelers used? ®WA 0 YES ❑ No DJ O Manifold/D-box errnwble from surface?- 0 0 El m= Check valves installed? . - 0 CI ❑ 62 Transport Line Size 2" Sctedule/Class 40 Bedrooms installed(check one) ❑2 x❑3 ❑4 ❑5 ❑8 ❑Commercial/Other >10 ft.from foundation? - ❑ N/A ®YES 0 NO 0 >100 ft_from wells? 0 ® 0 w >leo ft.from surface water?- 0 la W >10 ft.from potable water tines?- - 0 © ❑ 2 >5 ft from property lines and easements?- El la >30 ft.from downgradient curtain/foundation drains?- 0 ® 0 • Oreinfield level and observation ports present - 0 El 0 ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover Installed over drainfield? 0 - ❑ El Pump tank setbacks consistent with septic tank? 0 NIA © YES 0 NO Y Pump tank size (07 V gal Manufacturer Infiltrator < 24'access riser(s)and accessible from surface?- 0 a 0 ~ Alarm or Control Panel Installed? - ❑ ® ❑ IL• Control Panel equipped with Timer/UM/Counter- ❑ ® 0 D 0- Pump Installed in ❑ Bucket or a On Block or 0 Other fPump Make/Model 2 e- oa 0 / r N /yo I]Floats or ❑ Transducer a. Tank draw down 2.3 in/min Pump capacity. Ca gpm Squirt Height y f ft Pump on time /. 1- Milo Pump off time 6.0 A rr Daily Row set at 76o qpd Uvd.,S.mooda Mason County OSS Installation Report pg.2 Parcel a ABANDONMENT RECORD Were existing septic components abandoned as pan of this project? - 0 YEs NO If yes,please describe. Were all components pumped out and property abandoned per WAC2462721-0300? 0 NO RECORD DRAWING lies Ya Mncaent agent and wet be=unto and Mona•il d to Moan Y ma need a mtlntenw eatarbate end MO*eanadnm4 Two Record prettinite sawn. twit 4 noble aMa1An a*AM1 SepOcIpunip tank Ate.Not vlw.new4PNK oeSW and PNdll WISH.bYI.✓wllo wowi* oath.drmn*Sam M*de a Ind rtivm*4unm a®tussles}yplpaMR@.d Peelings may ate tl=een&Saw into.Yin 4pwl m.fast,Matt r ii 4 4c/L.to W4cord 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 actor- the septic design stamped"APPROVED'by Mason dance with the septic design stamped'APPROVED"by County Pudic Hearth and that any deviations shown Mason County Public Health end that any deviations here have been cleared/approved by both the designer shown here have been deared/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 an attached Record Drawing is accurate. form and attached Record Drawing/s accurate. /0/i//23 .,fata• t►` ' X t orinstaller_ Date 4a, ' i. F4iMbd NemeW Signet �q MASON COUNTY PUBLIC HEALTH / 6 '2( - . Q The undersigned approves this installation Report and L. . - fS f 4 r Record Drawing on behalf of Mason County Public 'Pi.\r Health: /s-2 i � t�`6Wl l (i3iZT s Signature of Enwronmentel Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAL.ABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE wane"Wale 0 0 Z. u n /1p Po m - ; 't pR 70a z - vg ' 4cgo higfrl3 •EQ 4 , Ao n I ;` 1 , ,, ry , 2013 -Ste.- , ` zzv EFr tirq mc_it, _ ,�It g v▪ � n } I � ,tq / l`7 w 0 4::-t m ti m t' `` /" •n �,� PJ Zs - ti �l iv' / la I W o m / 'I 't �° ,' I f 1� 4 9 n i. ti / h� j kt n w a 0 1 /� e'I s• . ( a d dolic 9 /96. /o ' I,.. 0 o n / N k Emmilimi N ,71 N 0. m 0 Z 01? P ti . �-1 a Nv I 1',111 0 1 N ' N N `R1V„ W Z a NC ` W N N. • O v ��// 0 N C W o ��ow- craws'. ti a C �§ r •h, G f n u tv 8 :co 11. oy � ti 3 0 k D '�ryti\ co EEn o�1 E v1 �• N A N n n 3 m i m !" \ • • 1 O O W Na ^ E SOVNO �\ _S. tie V or II a. \ 0 Nkit v n ;P n o a m 9 o y. flj N 444 E 0� ra 6 o R 1 1� v, . Rt ' 3 zo �, "' .� t� a. i�` { S ZSL- 2 Py i CZ P " ^_ �-yi s �� �i 1) I. � = 0 E a s, g m n ' a s Y0