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HomeMy WebLinkAboutSWG2022-00570 - SWG As-Built - 1/4/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2,0 ZZ - o 57r1 Parcel # 3 o2t 3-30-9 CO 13. © 4� Applicant Name 6-a�rtrt \ cT ( - Va R is Al.\L`/ Subdivision (Name/Div/Block/Lot) 7 9 ?�3 Applicant Address 3/,$Id tJ V S tl�l Y 101 RF�Fi/00 City, State, Zip t.t\1'tvJa a? uS►la . 9$555 Installer Name 6rj „}e JAb- Site Address vi't(1 ioio RA, Designer Name R t DcNicro INSTALLATION CHECKLIST SI Full System Installation D Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type -i-c.0 1-y _i zeivJ S . Pretreatment Type >5 ft. from foundation? - El N/A [OYES El NOEl 0 >50 ft. from wells? >50 ft. from surface water? ❑ ❑ 0 Z 0 Q 0 Cleanout between building and tank? 0 0 U Tank baffles present? - 0 d24" access risers over each compartment?- 0 ❑ 0 LU W Effluent filter installed?- Septic tank capacity (working) t ZO(& gal Manufacturer NIA ❑ YES ❑ NO 9 D-box water level and speed levelers used? - _ ❑ 0 0 �O Manifold/D-box accessible from surface?- ❑ 0 Oat Check valves installed? - /� 0 6Q ii �� Schedule/Class 303`� 2 Transport Line Size 0 4 0 5 El 0 Commercial/Other Bedrooms installed (check one) 0 2 ® 30 N/A p'YES ❑ NO >10 ft. from foundation?- 0 � 0 0 >100 ft. from wells? 0 ❑ 0 W >100 ft.from surface water? 0 ❑ 0 u, >10 ft. from potable water lines?- 0 1 0 z > 5 ft. from property lines and easements?- 0 r4 > 30 ft.from downgradient curtain/foundation drains? - - 0 0 Drainfield level and observation ports present - - 0 ❑ 12 Graveless chambers or 0 Clean gravel used? (check one) 0 Proper cover installed over drainfield?- 0 Pump tank setbacks consistent with septic tank? - - IR N/A ❑ YES ❑ NO • Pump tank capacity (flood) —gal Manufacturer ❑ El • 24" access riser(s) and accessible from surface?- rn ❑ 0 ~ Alarm or Control Panel Installed? - !`-J 0 0 a 2 Control Panel equipped with Timer/ ETM /Counter- � Bucket or 0 On Block or 0 Other a Pump installed in CI Bucket Floats or 0 Transducer Make/Model ft O. Pump gpm Squirt Height / % inlmin Pump capacity i d a Tank draw down Daily flow set at----------Updated Pump off time updated 81212018 Pump on time Mason County OSS Installation Report pg. 2 Parcel # 3 a4J-3-30' 96013 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES NO If yes, please describe: 7, NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ElYES RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield.existing and proposed buildings.location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Sg t: a; �H r0 +ToT. APPROVE JAN 042024 MASON COUNTY ENVIRONMENTAL HEALTH JIM 0 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 lneet 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 Rec. d Drawing is accurate. form and atta ecord Drawing is accurate. ,ff+ 0. Sig st "r Date i�Y7 ..17--- Printed Name of Sig,ee OF4 ' ✓, �`� I1 �K' 5100325 II OWEN DEr.91ER0 ANTHONY +' MASON COUNTY PUBLIC HEALTH 0';•LIOVN41.ti On'eil*A .R The undersigned approves this Installation Report and % cX i���o :Z�i��. Record Drawing on behalf of Mason County Public Health: 4 EN...2,--, itgi Sign.ure of Envi n nt I Health Specialist Date (stamp, signature and date) HIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 RECORD DRAWING (continued) 5 EE f3 yyp a ' • or,J t�bb 5CArC t'`=3o ' G 36gfd N• OS.H"-Wo' o tr 30. LlI I I i Wo[p L•\.b I c14555 A324-2-3-3o-906 t 5 . L 3 , u.ktob0,4Ra. - --e'' .. 19S•o l , c... r ax6,1Leep•:7AaL.Goo r e,.n4'&7 fl • R a' 3- :4;��- p-60�� Jra�J�'��oehl , -�''�� , ''\ , \ na G7 \ elsdlfs \ • ,. C)(3 a D CJ.t \ . - -` /7 / u o.05' 4 .'"---......_---- \ . f ARc17 Pin/, • / i / 4 Ic • A J 40 l%04/e ✓qN 0 V „;�,� or Co L- y Y i 'P0 lIe�Nr�jFNq` 4, l --4 --