HomeMy WebLinkAboutSWG2021-00278 - SWG As-Built - 11/17/2023 'cum FORM
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG -7'37.t Ge C ) Parcel# 222138100080
Applicant Name semy&oar! Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 3061
CO State. Zip Beha('. WA g8528 Installer Name Jack Johnson Construction INC..........
Site Address I' jc. s°s L- k Designer Name Jim Zmny
INSTALLATION CHECKLIST
• fit!!System Installation Tanks)Only ❑Oramtletd Only ❑Repair ❑Omer
System Type ro i tJ Pretreatment Type
>5 ft from foundation? 0 NIA a YES ❑ No
>50 fl tram wells? - 0 ® ❑
Z >50 fl from surface water? - El ® 0
H Cteanout between building and lank? - - ElCI5
O Tank baffles present? • - 0 • 0
2 24' access risers over each compartment?- 0 • 0
W Effluent filer installed?- ❑ II 0
N
Septic tank capacity (working) one gal Manufadurer HAGFAMAN
O D-box water level and speed levelers used? - - 0 NIA ■ YES 0 NO
J
oO Manifold/D-box accessible from surface? El III CI
u.
roof Check valves installed? - • 0 0
OQ
2 Transport Line Size 4' Schedule/Class 3034
Bedrooms installed (check one) El ®3 04 05 06 ❑CommercialtOther
>10 ft from foundation? ❑ WA ® YES ❑ NO
a -100 a from wellk?- 0 III ❑
>100 ft from surface water? - 0
mg ❑
IT >10 fl, from potable water tines? 0 III ❑ G-, o
deg- > s ft. from property tines and easements? ' ❑ ® 0
-
KEl Ill Elo
> 30 ft. from dowogradient curtain/foundation drains? - -
Dralnneld level and observation ports present - ❑ 5 El _._
0 Graveless chambers or a Clean gravel used? (check one) -
Proper cover installed over drainfield? 0 S 0
I
Pump tank setbacks consistent with septic tank? 0 NIA 0 YES 0 NI) a
! r
Y Pump tank capacity(flood) gal Manufadurer
< 24'access riser(s)and accessible from surface? ❑ 0 ❑
~
a Alarm or Control Panel Installed? - - ❑ ❑ 0
g Control Panel equipped with Timer ETM/Counter - - - - ❑ 0 0
2 Pump installed in 0 Bucket or ❑ On Block or El Other
!L
D Pump MaketModcl 0 Floats or ❑Transducer
0-
a Tank draw down innnln Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
.zaxt fi:•.t
Mason County OSS Installation Report pg. 2 Parcel a Z Li 'j d/Oe SO ABANDONMENT RECORD f�I
-f Jc zi Attu re A ' abarvm ic0& r f
t of rm. µgecr% - - ❑ YES NO
r.... rb.,v .u..0 n..
(a,npp6 ert et et pnq.ary Artereterret,t f r WM 146 et t ,"A): .. . ❑ YCh [] NO
RECORD DRAWING
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Record Draereg Altechod
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
crLty H r I r.' the ystern is,AA, cc'.Ydh I sorbly Owl Mb sys tAn.has b 5(aHe 10r.qox r
n4 4 5OP.,' a I . dn;pea'APPROVED'by Maxon claw wrih flux ^ttc Rsxtn stamped APPROVED by
r rofp P. 44h4nnrLl tCavalr rs shon•n Ma;or Cu ,nty Putte Heafh.and that boy durrabrnc
hrrohnm :.,DossALrappfore(l dy beft The ro^.,gner 5h oxn here ha to been rib lrntVippro vCI by holt.
).l bl, Ib. 111, out bus rchits mys. ta.rd Maa,n C, mry Pubs.t( bl u.r ;lobs os.,
suit^loam, Corroty UoOca Slate Tr,f Mauut COrrnly {wlas
fh[a sob., lb it„.0 ailorm iSowOniarnl_rr:to Ifutbe: cr>Uty tta1 ret7 r.umat ) wetted en0.4
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MASON COUNTY PUBLIC HEALTH
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