HomeMy WebLinkAboutSWG2021-00391 - SWG As-Built - 10/10/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2o2r - 0639/ Parcel# chi?o4- /3-om ir-e
Applicant Name 40JJ4..! S?ye✓cns subdivision(Neme/D1v/Block/Lot)
Applicant Address 7aen A'. U�e.c/L-.Ed,
City,State,Zip S/r 4./ ., 44.74 9sra'/ Installer Name eh sn-1. Ce✓.. Co..,24
Site Address C9// Ll-64n Le'it, Ro. Designer Name rA, l A/+ls"#J"
INSTALLATION CHECKLIST
u113ystem lnstatieson 0 Tank(s)Only 0 Drainfield Only [(Repair ❑Other
System Type ,4t45 . ,./).sY-, Pretreatment Type
>5 R from foundation? . ❑N/A I(q YES ❑No
rq>50 f.from wells? - ❑ ❑
Z• >50 ft.from surface water? ❑ al 0
< Cleanout between building and lank? 0 2 ❑
a Tank baffles present? ❑ 0 0
C24'access risers over each compartment? " ❑ 0 ❑
w Effluentftterinstalled?• - ❑ L ❑
In
Septic tank capacity(worldng) ILoo nal Manufacturer e0 plc
lere
Ill
1tcc
O D-box water level and speed levelers used? • ra N/A ❑ves 0 No
>Z O
J
ManHoid/6box accessible from surface? ❑ 0 0
m Check valves installed? ❑ IN 0
C Z IQ
f Transport Une SizeZ" Sct'• 8V Schedule/Class S / ZOo
Bedrooms Installed(check one) ❑2 ($1.3 ❑4 ❑5 ❑s ❑CommercialOther
>10ft from foundation? - 0 WA 0kas ❑ NO
>100(Lfrom wells? 0 ® 0
W >100 fr.from surface waled?- 0 ® 0
tit >10 ft.from potaMe water lines? ❑ 0 0
QZ >5R from property lines and easements?- ❑ 0 ❑
K >30f.from downgradientcunaiMoundationdrains/ 0 ® 0
O Orsini-mid level and observation ports present- - 0 1Z ❑
Graveless chambers or 0 Clean gravel used? (check one)
Proper cover Installed over drainfleld? 0 14 ❑
Pump tank setbacks consistent with septic lank?- 0 WA YES 0 NO
• pump lank capacity(flood)agar Manufacturer (j C-lt4 raIV pICS
a24'access risers)and accessible from surface?. - 0 Y 0
~ Alarm or Control Panel Installed?- 0 ie ❑
a• Control Panel equipped with Timer/ETM/Counter ❑wµ a- -�
a Pump Installed In ❑ Bucket or pi On BI r pir"'' ,'
-s
£ Pump MakeMlodel 7-0 2( ter N t nr \R 0 !,4.i Transducer
▪ Tank drew down . ' INmin Pump .5�'j 9pm., A9 4OM-1`I 2-
-
H
Pump on time -" - Pump eV H r�W Daily flow set at �iWpU gpd
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Mason County OSS Installation Report pg.2 Parcel a V/9 0 d/—/3 — and z e
ABANDONMENT RECORD
Were existing septic components abandoned es part of this project? 0 YES fit No
If yes,please desafbo: Y"
Were ell components pumped out and property abandoned per WAC24B-272A-03007 ❑YES Alit 0 NO
RECORD DRAWING
m41..permanent ewN one,real be.[area and 4*.ulpu.e enough to re-loca0 In N.need of mappens.tthw.and Men peeelppmmk Typal ILmd
Mewing.rmuhr DW6.admaMdd Pinkeye,dbrwt eeryWunit tank IdmYen,noMo,w resolve dmNwa eating PO peW..d Weed,Padaas np'e'an.,
wet.rdsoratOncadam%and OW mvnppncoMat Mob.hemp*Reefed Dia,gi ray crate Wd1Mi&lan n PPhUNMlko leplcOal and nitre CamSLL
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i'Ce a0 ecord Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system In accordance with I cavity 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 Hearth and that any deviations shown Mason County Public Health and that any deviations
here have been clearedeppruved by both the designer shown here have been cleered/eppmved by both
and Mason County Public Health and meet all State myself end Mason County Public Health and meet all
and Meson County Codes. State and Mason County Codes
I furtherce 1 n contained on this I further codify that all inlonnatlon contained on this
7orm an ecord Drawing score f� form and attached Record Drawing is accurate.
/0/3/,3 4 QPE814 ',
Sly of of In Mar L Date
Pon pick
Name of Sloes 7 d e
.� y
MASON COUNTY PUBLIC HEALTH Pf2E60Bg, \,rdp;
The undersigned approves this Installation Report and a_,,,, `/6YEa aG-.
Record Drawing on behalf of Meson County Public !N•
Health: . . y3
Signet CPT mental Health Specialist Date (stamp,signature and date)
THIS FORM MAYBE scaNNED AND AVAILABLE FORPUBLIC NEW ON THE MASON COUNTY WEB SITE Upddod°n1nom
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