HomeMy WebLinkAboutSWG2023-00254 - SWG As-Built - 11/16/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 023 - oe aSy Parcel# 6'/930 — 5/` 4006Z.
Applicant Name 77.n4;7z09l Izt— Subdivision (Name/Div/Block/Lot)
Applicant Address /O/ 2.:1145}/N 4-7; /24dt t 6 B TK 6 z
City, State, Zip Sne9 /4 "eery/ Installer Name /kPyt /3ReS.
I
Site Address 7/ -2-O L//, 47Iv4WD2 Designer Name r c £ 7 ee7-
INSTALLATION CHECKLIST
Pull System Installation 9 Tank(s)Only ❑Drainfiiel_d�Onyly 0 Repair 0 Other
System Type t scsi c ,bed.- Sent I I r`"-� Pretreatment Type
>5 ft.from foundation? - - ®NIA ❑YES D No
�a(� 57 rA
>50 ft.from wells? - - r�cr�<�/L'S � I+ 0
El
• >50tt.from surface w ? - ��i ❑
lin 2 - ® 0
F• Cleanout between buil find tank? - 0 gl El
• Tank baffles present? ❑
d 24"access risers over� i eompartment?--- 0
W Effluent filter installed? ❑ El ❑
W Septic tank capacity(working) 17 5 O gal Manufacturer fill
O D-box water level and speed levelers used? - - ® ❑YES El NO
NIA ❑ 0
�O Manifold)D-box accessible from surface? 0 0 0
nt= Check valves installed? -
t]< it SchedulelClass sal2 Transport Line Size 2
Bedrooms installed(check one) gr 2 ❑3 ❑4 ❑5 ❑6 ❑CommerdallOther
® NIA ❑YES ❑ NO
>10 ft. from foundation?- 0
0
>100 ft. from wells?-
-I >100 ft.from surface water? 0 ® 0
W
LL >10 ft.from potable water lines?. 0❑ I`NL 0
0
C >30 ft.from downgradient curtainlfoundation drains?� 0
ct > 5 ft.from property lines and easements?-
Q 51 0
� ❑
• Drainfield level and observation ports present - 0
0 Graveless chambers or lI Clean gravel used? (check one) 0 El 0
Proper cover installed over drainfield?-
Pump tank setbacks consistent with septic tank? ❑ NIA
14 YES ❑ NO
• Pump tank capacity(flood)_31.5.0_g Manufacturer Efilal ® El
24"access riser(s)and accessible from surface? ❑
El
Alarm or Control Panel Installed? 0 ® 0
2 Control Panel equipped with Timer I ETM I Counter-
?
D. Pump installed in ❑ Bucket or ® On Block or 0 Other
1 ❑Floats or 0 Transducer
g Pump Make/Model 2 Or1IOC i53 5 ft
Tank draw down 2 in/min Pump capacity SD gpm Squirt Height
6 11
Pump on time_ /-2._ Mfa Pump off time Y10VrS Daily flow set at 240 gpd
_ updated emQple
Mason County OSS Installation Report pg. 2
Parcel# 6/T 30-5i ;48b6 2--
ABANDONMENT RECORD �,
Ell YES E- "o
Were existing septic components abandoned as part of this project?
It yes,please describe:
o
Were all components pumped out and properly abandoned per WAC246-272A-0300? 0 ifs
RECORD DRAWING
relocate in the need o'maintenance activities and Mum development Typical Revd
Tide is a permanent th record and mud Be tacm& and descriptive enoughto relocate
North bumf brain awois.walesse:.
Drawingsobservation
ports
deaautmom orientation Bbice mess Degas/pump MrcmPSeb Record Drawing:may xe adaticaatdel m:pm arrNavu'a�ion angelical and misled centie.
welts.otxiarw.dan�.aunoma.and Omer mYnLeriaMe mess coma
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that l 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 and Mason
aso Coount Public Health and meet all
and Mason County Codes. all
I further certify that all information contained on this I further
eand ettachhatRecnffd Drawing contai
is wand of n this
form and attached Record Drawing is accurate.
/ - ' i3
p4,
Date ..
_.. AaH �
Sig azure of Installer / ar±v
Sea, you 6- �. i • �.
Printed Name of Signee z ¢c
{
MASON COUNTY PUBLIC HEALTH to t
!l, 8 50 c \�+
The undersigned approves this Installation Report end F 13 501� 6
Record Drawing on behalf of Mason County Public of/ONAL E�
Health: yzJ
Signature of Envimnm ntal Health Specialist (stamp. signature and date)
Date uoa.maer+md+d
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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