The URL can be used to link to this page

Home My WebLink AboutSWG2019-00308 - SWG As-Built - 2/7/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG \9 0034 Parcel # _2 33U - S-CD- QQ Applicant Name '\.)�k1 5--.?A' 1-.z. Subdivision (Name/Div/Block/Lot) Applicant Address .f((%U - t, - ler City, State, Zip .9* f I,./ -q 8 Yee S Installer Name A.c-2,i - pcCo.%3 QA-14A, Site Address 16\.q0 N C `7"Ahv o Designer Name IJ JA v,\c3.Q S vv\XU-, i)r INSTALLATION CHECKLIST ❑ Full System Installc n ZTank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type �-3 e SS Lk r Pretreatment Type >5 ft. from foundation? - - ❑ N/A TZ YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Z >50 ft. from surface water? - - ❑ (� ❑ HCleanout between building and tank? - - ❑ 21 ❑ U Tank baffles present? - - ❑ ® ❑ H- 24" access risers over each compartment? - - ❑ ® ❑ d W Effluent filter installed?- - ❑ A ❑ cn Septic tank capacity (working) r,o o D gal Manufacturer 1'4 et-2tr" r\CYr- Vre-CSD,S4-- 0 D-box water level and speed levelers used? - - ElN/A ElYES ❑ NO XO Manifold/D-box accessible from surface?- - IA ❑ ❑ m Z Check valves installed? - - .0 ❑ ❑ ❑< 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO 0 >100 ft. from wells?- - ❑ ❑ ❑ W >100 ft. from surface water? - - ❑ ❑ ❑ >10 ft. from potable water lines?- - ❑ ❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑ ❑ Q cc ❑ ❑ El 30 ft. from downgradient curtain/foundation drains? - - fra Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - ❑ N/A ZI YES ❑ NO Pump tank capacity(flood) 1 0 0 0 gal Manufacturer lac.-cv.kv-vv._0_,: ,c -$, < 24" access riser(s) and accessible from surface?- - ❑ ® ❑ ~ Alarm or Control Panel Installed? - - ❑ ® ❑ a 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ ❑ ❑ D n- Pump installed in ❑ Bucket or VI On Block or ❑ Other a Pump Make/Model xi Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 821/2018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES ❑ NO If yes, please describe: �`f�-., 1 Y S Were all components pumped out and properly abandon d per WAC246-272A-0300? - - ❑ YES ❑ NO 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 drainfietd,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. I• ❑ 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 m and attached Record Drawing is accurate. form and attached Record Drawing is accurate. ature of Installer Date \ vkA_. use Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: s 7ih (2.1 Signature of Environmental ealth Specialist Date (stamp, signature and date) Update Ai21;20t8 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE RECORD DRAWING (continued) 1S�^�� d�S\µ�L • f � , — -40rl i 4' 4o4- "-i- - - -\ - - - `� !i D A 402' F. 5 i " > 7R �+ o I ' s f� C a n tr. } a � �'1 - Oil i ? a a A V A2 0-c ! O 400' o c n A i t i s r, ^ •�. - = a cf, \a M �' W 3.C r is \ Z Et i b re R 4 �D n , Q : 1 g 3981- - � -398' q • ( _ = I o c'", u u f 396 - - . -396' c 1 ;o t 1 � I T r cF1-.us��a 1 094' r 394--- r--_-` p. Cn -•_. i• I _ • I ,'r '' 1. \`y�fi. I ).- co <: `` • I R —J.I • `\ 1 392' (n p _ i I . • ` .;fie{ 0 `.8 n Z 13 l 392' f a O SOPI Efl LLc�•S 396.- , - - - _ �.n Wrzi ,�a— ;i_r--386' r- m C �_ o is -n `=1 \I<a> /N TT 70 5 O cp i - - _ ~ OS0�i; �.- ram i ® I �� r-� z rn :.,_ ' ` _ 382'r_ ' �. _�_ 82' W 380' . - _ - _ _� _ — 380. Fm( _ _ roto,.. ..., i, _ _ __ _ 1 �78• � � 378' _ _ I 2::