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HomeMy WebLinkAboutSWG2023-00211 - SWG As-Built - 10/16/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 0 Z • Parcel # 1 2,i 0 i?' iZ -OOZOC. • Applicant Name Ck-A-Sii Subdivision (Name/Div/Block/Lot) Applicant Address //1Y, 1�// 1�,` y� City, State, Zip '�,'CT eta llI,,'' �{y5q taller Name J�L�n sC 171 Site Address _ CV O- Designer Name \ 'Oinn c r ref ts..A INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only 0 Drainfield Only ['Repair ❑Other System Type ns use Pretreatment Type X02 ec cc.( >5 ft.from foundation? - ( � � T7 - ❑ N/A NI YES ❑ NO >50 ft.from wells? - woo�1 0 ® 0 Z >50 ft. from surface water? - ❑ 0 F Cleanout between building and tank? - ��.:—ra - ❑ NI® 0 U Tank baffles present? - 0 ® 0 a24" access risers over each compartment?- BY: - ❑ ® ❑ W Effluent filter installed?- - 0 ® 0 CO HillSeptic tank capacity(working) 12 50 gal Manufacturer CI D-box water level and speed levelers used? ® N/A ❑YES ❑ NO OO Manifold/D-box accessible from surface?- 0 GI mZ Check valves installed? - - ❑ ® ❑ OQ 2 Transport Line Size Io Schedule/Class Sc1rLIO Bedrooms installed (check one) ❑ 2 03 ❑4 0 5 ❑6 ['Commercial/Other >10 ft. from foundation? - ❑ N/A ® yes 0 NO G >100 ft.from wells?- 0 ® 0 W >100 ft. from surface water? - 0 ® 0 E >10 ft.from potable water lines?- - ❑ ® 0 z > 5 ft.from property lines and easements?- - 0 0 0 Q K > 30 ft.from downgradient curtain/foundation drains? ❑ Ea ❑ Drainfield level and observation ports present - - 0 121 ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ® ❑ Pump tank setbacks consistent with septic tank? - - El N/A ® YES ❑ NO • Pump tank capacity (flood) 12SO gal Manufacturer 1-1TS < 24" access riser(s)and accessible from surface?- ❑ ® El ~ a Alarm or Control Panel Installed? - - ❑ ® ID • Control Panel equipped with Timer/ETM/Counter- 0 ® 0 a Pump installed in 0 Bucket or ® On Block or 0 Other fPump Make/Model n(coco 51 ® Floats or ❑ Transducer a • Tank draw down k in/min Pump capacity 50 gpm Squirt Height l(Vp ft Pump on time osa.( Pk. Sa-y1 Pump off time es ca ?u SC\ Daily flow set at 270 qpd updated envm+a l Ian "- I - ND Parcel# ace Mason County OSS Installation Report pg. 2 a ABANDONMENT RECORD I Were existing septic components abandoned as part of this project? YES El NO I If yes. please describe'. NO Were all components pumped out and properly abandoned per WAC246-272A-03001 YES RECORD DRAWING This Is a permanent record end must be accurate and descriptive enough to a-locate in the need of maintenance activities and future development. Typical Record Drawings contain Dainheld&manifold orienladon&layout,Septic/pump tank location,North arrow,reserve grainfield,existing and proposed buildings.location of wens,waterenes wells.observation pans cleanoms and order maintenance access point. Incomplete Record Dawirgs may Create additional de'ys in final installation approval and related perrnns. jil 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 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. � Sign lf ,QoPa .Installer 81l1—al2J ;/IDateIIIg tq z'3 Ill -IC- A nb2ti— — .PFII Printed Name of Signee E•• .Ill Sco•.. sdil•l MASON COUNTY PUBLIC HEALTH 5,c ' rxi, The undersigned approves this Installation Report and L_ � '•• ill Record Drawing on behalf of Mason County Public r' n r l fen Piker. 111 Health. % LICENSED DESIGNER ll `2 f nv2nrne 1 (t lib (23 12 t1 Z 9 Signature o/Envtronme al Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updmad amzpte \11111 a3 z e.(.4 r. 'h \r .Ag 2 {4� is S•FN'\1�11t11 Af S'A O (Ol �iS/� x . ••• 11 'RXMP� S •o Jc •',R.11j1�. 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