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HomeMy WebLinkAboutSWG2022-00262 - SWG As-Built - 10/10/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2,02�L. - 00 26z Parcel # 6/?2...e - it-y - 1oc3o Applicant Name Ro&E'I T TSSie 4/2 sSubdivision (Name/DivBlock/Lot) Applicant Address 5-0/0 24' rv, Sj E. City, State, Zip 6,eAHf m, wA is373 Installer Name OwNE,2 ,Roes',,nerasuvee-r Site Address 6"95/ r+'• S-r rota CZQ&4U+iDesigner Name c"K is Fcsm=tT a, INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ['Repair ❑Other System Type 6/�/v✓/7 y - 71e4-14.4-6-1 Pretreatment Type >5 ft. from foundation? - - ❑ N/A es 0 NO >50 ft. from wells? - - ❑ � ---- 0 Z >50 ft.from surface water? - ❑ ❑.,�/ ❑ F Y• Cleanout between building and tank? . - ❑ L ❑ O Tank baffles present? - ❑ Er' ❑ H 24" access risers over each compartment? . - ❑ ❑ a W Effluent filter installed?- - ❑ 12 ❑ to Septic tank capacity (working) /2-OJ gal Manufacturer House Brothers ❑ D-box water level and speed levelers used? - - ❑ NIA Ly^'C5 ❑ NO oJ ❑ ❑ u.O Manifold/D��box accessible from surface?- mZ Check valves installed? - - 0 - ❑ ❑ 0< Transport Line Size Schedule/Class_ Bedrooms installed (check one) ❑ 2 1❑4 ❑ 5 ❑6 0 Commercial/Other >10 ft.from foundation?- - ❑ NIA [}its ❑ NO ❑ >100 ft. from wells? - ❑ Q� ❑ W >100 ft.from surface water? - w w{�,- ❑ �� 0 LL >10 ft.from potable water lines?- - - - 9y/-1'� ®4 -- ❑ ❑ � >5 ft.from properly lines and easem v- E 0 0� ❑ a ? 1 d2U23 - - p, ❑ ce >30 ft.from downgradient curtain/fou n d Ft1�- ] ,r,/ Drainfield level and observation pods e t - - -- - - - - — - ❑ L7 ❑ 3- -veless chambers or ❑ CleaffgreWerused?JnAk one) Proper cover installed aver drainfield? ❑ a-- ❑ Pump tank setbacks consistent with septic tank? - ❑ NIA Q res ❑ NO • Pump tank cap y _ gal Manufacturer Q24" access riser(s) and accessibl rom ❑ ❑ ~ Alarm or Control Panel Installed? - - - - ❑ 0 o. ❑ 2 Control Panel equipped with Timer/ETM /Counter- ❑ d Pump installed in ❑ Bucket or n Block or ❑ Other -_. O.• Pump Make/MM ❑ Floats or ❑ Transducer a draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd undauw 8I2IR018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ES ❑ NO If yes, please describe: O L 0 f ' f7c r 2NiC Were all components pumped out and properly abandoned per WAC246-272A-0300? El NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to reaocate in the need of maintenance activities and future development Typical Record Drawings rnnlain: Drainfield&mandold orientation dlayout,Septc(pump lank Iordllon,North armw,reserve drainfield.existing and proposed buildings,loCation of web.waterlines, wets,observation ports.deanoub.and other maLlenana acCCss points_ Incomplete Record Drawings may aeate additional delays in final Nstalladon approval and related permiLs. • Pic 04//A"(4 ecnrd 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 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 certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. KU O 7Jr-, 10/09/23 Signature of Installer Date aQR EB(ENE, Robert Essenpreis • i so Minted Name otStenos ,��• % r MASON COUNTY PUBLIC HEALTH `• _� e 0 28508 ' The undersigned approves this Installation Report and ^F„ PF. tO �_ Ret'brd Drawing on behalf of Mason County Public r�8y elan? d Health: *NA ti (t)-119-2--3 6 z2— z3 Signrptu nvironmental Health Specialist Date (stamp, signature and date) / THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updmed W21/2010 r \ } > § 1 \ \ ƒ \ / z \ . ° § § ! . \ w } » \ : , \ \ . \yam at 1 !'' u /2C40 ° 2 \ } 1 w< > / � « w \§ a ° — »yz � y - d I. L- , ` _ \ « N / MS ro ® y \ J « & # CI , ■ C CC « n \ \ 0 '\ \ ) `c \ } \ / \ \ \ . . d . f : \ ) \ > ' 3 — ^ \ \ \ \ J � « < \ ` § ` ° �© \ . j /; d ` ' %^ � . \ ,