HomeMy WebLinkAboutSWG2022-00471 - SWG As-Built - 10/16/2023 Mason County OSS Installation Report pg. 1 " \l MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION r—�J\
ra
Permit Number SWG ZOZZ ' ( Parcel# 42a13 - a.a.- IDS$ -. ii±:,\
Applicant Name 301 n epC v\vvekk Subdivision (Name/Div/Block/Lot) -` a'
Applicant Address a -t Sw P lan W L I rc, ;�
w M
City, State, zip Svtc the. `\ 1p Installer Name Qu a1 Plt,.Sk b
Site Address a1-t�+OVASNc r}pt' rt./h 1 OI & G_f
� Designer Name Ftatavr AA UK
INSTALLATION CHECKLIST
❑ Full System Installation jT�ann/k,(,$)Only 0 Drainfield Only 0 Repair 0 Other
aM
System Type Np 7-fc r13AQR -7 co Pretreatment Type ATK
>5 ft.from foundation? - ,ter
>50 ft.from wells? - ❑N/A �YEa ❑ NO
_ >50 ft.from surface water? o 0 0
F Cleanout between building and tank? P❑� ❑
V Tank baffles present? - - 0 0
a
24'access risers over each compartment?- 0
0 ❑
y Effluent filter installed?- 0 El
tank size !SOD gal Manufacturer W Ma 4 - 3 0
0 D-box water level and speed levelers used? -
,O Manifold/D-box accessible from surface? ❑ WA YEs 0 NO
Da Check valves Installed?
0 g ❑�
f Transport Line Size 1-7 0
Schedule/Class W✓l VW KVO
Bedrooms installed(check one) El2 El3 ❑4 ID �r•
5 Vye Commercial/Other
>10 ft.from foundation?- -
y' ❑
G >100 ft. from wells?- ❑ WA ❑ YES ❑ No
0 0 0
w >700 ftfrom surface water?- ❑ 0
0
Z >10 ft.from potable water lines?- 0
` >5 ft. from property lines and easements?- - ❑ ❑ 0
e >30 ft.from downgradient curtain/foundation drains? ❑ ❑ O
O
Drainfleld level and observation ports present - - 0 0 0
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield? 0 0 0
Pump tank setbacks consistant with septic tank? ,,�,(`RY-
❑ WA Ea 0 NO
2 Pump tank size (ZOO gal Manufacturer /f4-6t€fin"'
IQ- 24'access riser(s)and accessible from surface? ❑ it 1:1
a. Alarm or Control Panel Installed? - - 0
j Control Panel equipped with Timer/ETM/Counter- El0
S Pump installed in ❑ Bucket or n Block or ❑ Other
a Pump Make/Model 1-fge'' LF z6(J r���
a �7 t pats or
0=. Tank draw down �.S ❑ Transducer
Nmin Pump capacity ,5 qpm Squirt Height 10-4- ft
Pump on time / NJ Pump off time 2 h r Daily how set at &ICC qpd
Updated YL,(A,9
Mason County OSS Installation Report pg. 2 Parcel# `}3—a17 2 2 - 1 CSS'}
ABANDONMENT RECORD
Were existing septic comport�,jis abandoned as part of the project? - I''I No I
If yes, please describe: /I'r/ old „5.2."-d O'/rryr- r /pi, A✓K S(s/i( ct- 7
Were all components pumped out and property abandoned per WAC24fi272A-03007 - S fftMMMr��4 ttt❑NNN
NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re-lecate In the reed of n.NWUMe=edges and awe development Typrnl Recant Drams contain: Drewwa&manifold aienlann a layout Septic/pump tank isogon.NUM arrow.reserve&anfield.eaa lag and prttcsed Iadgg3.bcani oreapc.%tables.
wens.observation pods.amours,and oth maintenance m ten access wit. incomplete Read aadnas may create additional dam In gnat installationinstallan approve ame:
as maw c
GAM3t 1QGrs r c 300 q . t,9 k I- sal b Pitk At 7-ei0/ate
I,.,,4-k 4-U4kyv- 4 (7c0 I cot/. fC/rauI-C
(}er(aic Fay 1 34.1/49 4. ( Zee -4.., w, +L RV 2 15G
iNO—wn-T&R wt.1kl -eysil-ir taco rAMIc AS -rni-S'f TuK
�cV (2ri7J waif( To `73-oul-'✓C- (Yoc?s/ 4, live) 144.p>`Z✓r: trw---P,( -4.
6br iN+-tHr iv Dc chef/rn. X lv, o_$ox tJ Si°e201 laktie° s 4c,
Drn,v clic"-
,cgiastecord Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that!installed the system in accordance with
I annoy that the systemtd has been edinstalled"A in accor-
"APPROVED"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
hem have been cleared/approved by both the designer shown hem have been cleared/approved by both
and Mason County Public Health and meet all State
and Mason County Codes. myself and Mason County Public Health and meet all
State and Mason County Codes
I fu reify that all information contained on this I further ce dac that all information is accur on this
Po • :ttac-;• Record Drawing is accurate. form and attached Re?co�/�D�f/'w��hg is accurate.
0�O �3
5t : . Installer Date - tl
r/✓ P 6�f or/ye z3 -:V / �,- S
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH n t
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public t^ Yyl
Health: '
4fr4C0171 ( O ( 4[z3
Boat.of Environmental Health Specially Date
(stamp,signature and date)
THIS FORM MAY BE SGNIED AND PAYABLE FOR PUBLIC VIEW ON THE MASON COUNTYWEBSRE ttmwu Sapad1el
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