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Home My WebLink AboutSWG2022-00310 - SWG As-Built - 10/6/2023 uc)/ OCT 5 2 023 Mason County OSS Installation Report pg. 1 MASON COUNTY UBL49&Ef AL APPLICANT/ PERMIT INFORMATION Permit Number SiNG 2C22'CAA 117 Parcel# 37 7.utcl 0 0uS0 Applicant Name t&t3c, e \ vt Yt'Nitt-. Subdivision (Name/Div/Block/Lot) Applicant Address II L]zu fkY <l` ,City, State, Zip CJ KO xm�,WC\ q, 19k Installer Name �'mca taro Site Address 'tio .SC kSc5k.n 015. Designer Name 1--r(1nYl to Ar/1L (pullINSTALLATION CHECKLIST (pull System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type 6SCA.0 Pretreatment Type OSCat >5 ft.from foundation? - ❑ WA ®YES ❑ NO >50 ft. from wells? - ❑ N ❑ Z >50 ft.from surface water? ❑ IT ❑ FCleanout between building and tank? ,.),i� ❑ al U Tank baffles present? - ' 1J h ❑ N ❑ 6. 24" access risers over each compartment? _- - 0 N CI W Effluent filter installed?- - - - - - ❑ til ❑ n I. HIS Septic tank capacity(working) 1500 -gal Manufacturer ❑ D-box water level end speed levelers used? ® N/A ❑YES 0 No GLL Manifold/D-box accessible from surface?. ❑ ® 0 fC= Check valves installed? - - ❑ ® 0 cQ 2 Transport Line Size I a Schedule/Class Sth 4 O Bedrooms installed (check one) ❑ 2 I 3 04 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ WA N YES ❑ NO o >100 ft.from wells?- 0 ® 0 W >100 ft.from surface water? - ❑ N 0 Li. >10 ft.from potable water lines? - 0 ® 0 QZ > 5 ft.from property lines and easements?- - ❑ ® 0 K > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑ ta Drainfield level and observation ports present - ❑ ® 0 ❑ Graveless chambers or El Clean gravel used? (check one) Proper cover installed over drainfield? ❑ ® ❑ Pump tank setbacks consistent with septic tank? - ❑ N/A N YES 0 NO • Pump tank capacity(flood) 1200 gal Manufacturer HY3 Q24" access riser(s)and accessible from surface?- - 0 21 0 a. Alarm or Control Panel Installed? ❑ I El a •Control Panel equipped with Timer/ETM/Counter- ❑ 13 ❑ a Pump installed in 0 Bucket or ® On Block or El Other d Pump Make/Model eccn , M SI Floats or ❑ Transducer r u r��w{odown 1 in/min Pump capacity 45 gpm Squirt Height ILf A/Drip ft •Pu ob'll Sdr eSCLr Pump off time pr..ft} 6SCLr Daily flow set at 270 qpd OL/ /i vodai.d vz V2018 6 2023 Mason County OSS Installation Report pg. 2 Parcel# • ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? ❑ YES 0 NO RECORD DRAWING This Is a permanent recimd and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typlal Record Drawings contain orainnela Z.manifold nnental'mn It layout,sepadpamp lank location,North arrow,reserve drakdeld.existing and proposed buildings.location of wells.Wammnes. wells,observation ports,cleanouls,and other maintenance access point.. incomplete Record Drawings may create additional delays In final installation approval and related permits. ®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 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 l 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 Dr is accurate. Ft Sign ure of Installer Date 3 ef • le lino . Printed Name ofSignee MASON COUNTY PUBLIC HEALTH e M d' � The undersigned approves this Installation Llepotj 4923 Y Ao MJ HUNT En T,r Record Drawing on behalf of Mason County ubhc r I rv-1'fi 1f1 ti c upp"' t i�TSS`.a.�ti`s<XXSJ Health' to EN\R °tiAl.H61LT,1 tt a Lt y Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updaed luvrzme o \ U _ O \ \ s [ } \ \ ) , m = . - 12e , / ' ' y ( ) ) j \ ; \ ƒ ± . , . ^ ( Is cn \8 I. : _ _ m !=! : ! 2 \ '0 ; i ; \ ! ( \ ! 5 ; , ! .2 } I11 « y_ ` ! ^\ m� © ( : } : ! ! ( r il } � u. -- ,. !