HomeMy WebLinkAboutSWG2021-00384 - SWG As-Built - 3/1/2024 Mason County OSS Installation Report pg. 'i MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG
rF 2 (.-CC- 39-- 4Parcel # 2�2-iOti - LI41 D
Applicant Name G'td1G1k) Eht.IJ l Subdivision (Name/Div/Block/Lot)
Applicant Address 3`Lv7 e_a ri l +2-1- QQ _ �����
City, State, Zip vY--rzi (Wei. '$?Z Installer Name r- 5 `. - L(
SA' - Designer Name .Strom. 1�'r
Site Address 9
INSTALLATION CIAECKLIST _.
Full System Installation ❑Tank(s Only ❑ Drainrield Only ❑Repair ❑ N/
System Type I IY-4.0✓k ��_.-__- Pretreatment Type /J
>5 ft. from foundation? - ❑ N/A 4:1YES ❑ NO 1
>50 ft. from wells? ❑ ❑
ry >50 ft. from surface water? - 0
❑ 1
czt Cleanout between building and tank? - - ❑ U
U Tank baffles present? - - - El [1
d
C�I Li
access risers over each compartment?- - - ❑
W Effluent filter installed?- - - - - ' - - ' ❑� g ❑ r
Septic tank capacity(working) 17 ____gal Manufacturer C
� t' '
Q D-box water level and speed levelers used? . - - - /A ❑YES 0 NO I
OO Manifold/D-box accessible from surface? - - ❑ ❑
o?•; Check valves installed?
11 - ❑ % ❑
5 Transport Line Size Schedule/Class 1+0 i
Bedrooms installed (check one) ❑ 2 kr3 ❑4 ❑ 5 ❑o ❑Commercial/Other
>10 ft.from foundation?- -• -• ❑ N/A YES ❑ NO l
L >100 ft. from wells?- - ❑ ❑>100 ft. from surface water? . -- ' ❑ t>10 ft. from potable water lines?- • ❑ ❑ I
5 ft. from property lines and easements? ❑ ❑ r 30 ft. from do;^�ngraciiar:t curtain/foundation drains? - - - - -• - - - - ❑.,/ ❑Drainfielct level and observation ports present - t ❑ C
XGravetess chambers or (_.1 Clez.n gravai :sed? (check one) _
Proper cover installed over drainfieid ' - - - - - - - ❑ �_ _ _
Pump tank setbacks consistent with septic ':ani<? `; N/A YES ❑ NO 9
t 1 D
_ gal Manufacturer 5-Z1-4'� l�
Pump tank capacity (aoo.).
saccessible from surface? _ .. .. _ _ .. _ . fl g V
>-f 24" access riser(s)and
�- �, ❑
Alarm or Control Panel Installed? t�
Control Panel equipped with Timer!ETivi/Counter- •. - -• - - - •- -• - . ❑ ❑
n
;!.- Purnp installed in ❑ 8,_:cl,F;i. or )‹.i Or. Block al. [] Other.____.-----_---- ---- — -- f
p"�
Pump Ivlake/Model_�: C -/\el. --N. -- -.-..-- ;oats or 0 Transducer
:ID .� . rn Squirt Height_., - __ft
11
�. Tank draw down_ _. ____in/min Pump capacity- Cr.....
� -__yP � 9
Pump on time :2•1D Pulp off time c N( Daily flow sett 210 gpcl 1
uramedu21;nia~
Mason County OSS Installation Report pg. 2 Parcel #
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - (] YES 0 NO
If yes, please describe:Were all components pumped out and properly abandoned per WAC246-272A-0300? - -- El YES [] No
RECORD DRAWING
This is a permanent record and must be accurate and descriptive onough to ro•loc to 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 pens.cleanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays m final installation approval and related permits.
El Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
I certify that 1 installed the system in accordance with 1 certify that the system has been installed in actor-
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
1 further certify that all information contained on this 1 further certify that all information contained on this
form and attached ecord Drawing is accurate. form and attached Record Drawing is accurate.
1-7 ( c-1
Signature f installer Dale
1%61 —
Printed Name of Signee 1� A Z/z47/2-14_,
MASON COUNTY PUBLIC HEALTH .. j
The undersigned approves this Installation Report and ;o� 22030(i34
y pp P _. - lU'''' RUSS�It..- .'
Record Drawing on behalf of Mason County Public
LICENS ES N
Health:
kAiNcr-C,MoczrYin 361.2;1
Signature of Environment l Health Specialist WV Date (stamp, signature and date) 4 J
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON TI lE MASON COUNTY WEB SITE U0a1nd812t/2gt8
I
GARAGE
Q w/BATH
m = O � cmO GOO() • —WATER 1m
mrn O �
cn v) m i> D = � � N
v) rnxi -0v> Z 08888E I rn
cD < vn . •T, Zoom
mm O -rSmr roo0
O
xi rnN Z m - Z -0v'Zm Km
v ( IIi.) 700D --°Om V� wocrm n v 2
w
v) iD o 2 O_i n _ -4
Cm 0Z 2 D O 0
DZ m0
m v,- � � Om = > 7C
Z 11 GO
- OZ Z II
0 2 0' li I
rn
N
i co
Z c 0 6- Z O f
N > ID a
rn
70 OZ o
2- -n m •) IN 1
m
o
i
a
� �
CZ)
O r o / \ I
d \
o /
a I ,717
r- rr- \ . N
N` �'0 N N N // I
NN
\ s\ U I
N
N.
vD om cnz70�
70 rnA cn ➢
I 0
n O
p = z DO -ic
TmO ZF. 0 I
N
.. Z
op -1
0g2
m
00-o
Z• m0 >
O m 70
IT1 m
D 0
Oily
D m 0 S0'F•
O -Dt Z Z~ w�STF I \\ _
m N _— � '
H � alli
0 � ; opt R' • I \ - - - ---- i
—
07 1 N F. '�` --
• O T Vil
; Z m a S`H ` � __ -' - • • -�' • -fir
V 1)\-‘ N ( ir 1°
mZ
0 � V A A� D m
mKN›� O - 47 /I z- m0m> ZI �
I�,
74
r' c) Di n
0 v> 7, 0 m x y r I
D g_ D D v g
Fn i r o - 3 0 =
N 4k I
N w U)
� m
g I
oo A O cn N m n th
N N
-� O 7C O I
CO (..) m o -D •v,i U) o,
z
*
Zm H
3 Nm o Z DC I I 3p
CM NA. > O 73 O O O
- -1:) 0 ° 2° co -I (:: .°"<*---- - gx
CT)
p z Iwo 1- 0 a SN mm
rL• JT
Zrn m 0 O m on c 70m rn
co
S8'>86
r V Z -1 A
o N N C)
.A. m m
0 DC
m
4 Z