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HomeMy WebLinkAboutSWG2021-00091 - SWG As-Built - 2/22/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG jc z - 000q Parcel #qLL t-L25-0 , X7)'L- 1 Applicant Name L._t E Subdivision (Name/Div/Block/Lot) Applicant Address City, State, Zip Installer Name S -.. 1-1tk---1 Site Address v1-2)0 1S \, 0 Designer Name \ t\2---12 INSTALLATION CHECKLIST ull System Installation ❑Tank(s)Only El Drainfield Only ❑ Repair ❑Other System Type N u \1'A--V iZ_. Pretreatment Type >5 ft. from foundation? - �- •43.rt. ❑ N/A E YES ❑ NO >50ft. fromwells? - - =- -1-- -—/•,1 to o- El,y Z >50 ft.from surface water? - - - - -��- 2 - - ❑ El HCleanout between building and tan - ` - ❑ Er El U Tank baffles present? ppp,� ;.'t�.1'L''_ ',,_�iRONMENTAL HEALTH❑ ❑, ❑ a24"access risers ove each compartment?- --- LBW - ❑ lY El tW Effluent filter installed - - El Er ❑ Septic tank size l2C cz) gal Manufacturer 1 tJ1`tc-T1244-11b►'L o D-box water level and speed levelers used? - - [�N/A El YES ❑ NO oO Manifold/D-box accessible from surface?- - Er El El oQ Check valves installed? - - ❑ EK ❑ 2 Transport Line Size 2-.1` Schedule/Class '-/'b Bedrooms installed (check one) ❑ 2 0 4 0 5 0 6 El Commercial/Other >10 ft. from foundation?- ''`X '{I -1 �}�-f+r-1 ❑ N/A [''YES ❑ NO >100 ft.from wells?- 4 11��77 L� i1 1,� ❑ E ❑ 11.1 >100 ft. from surface water? ' ff -o- 7Q24- El 0 ❑ u. >10 ft. from potable water lines?- - ❑ Er ❑ Z > 5 ft.from property lines and easements?- El CT El Q Q >30 ft. from downgradient curtain/foundation drains?--=- - - ❑ [T 0 Drainfield level and observation ports present - - El I:3-' ❑ ❑ Graveless chambers or atlean gravel used? (check one) Proper cover installed jver drainfield?- - ❑ EK ❑ Pump tank setbacks consistant with septic tank?- - El N/A ErYES 0 NO Pump tank size ('LUb gal Manufacturer I t-J rt LT _'t'CbYL Z < 24"access riser(s)and accessible from surface?- - El ❑ a Alarm or Control PanelIInstalled? - - El ©- El E Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ m d Pump installed in ❑ Bucket or On Block or ❑ Other d Pump Make/Model -"LDe - -C'YL t La 1 - COOZ-. oats or ❑ Transducer d Tank draw down `- 1 ( in/min Pump capacity ' .I. gpm Squirt Height S ft Pump on time 2 nn i�v Pump off time i-i ke-5 Daily flow set at '5Ca es gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# i •`. ABANDONMENT RECORD i Were existing septic components abandoned as part of this oroiect? - O.4cs s 0 No If yes, please describe: DE Orrt>531 o NEt cx c i N iL gp cK. F-ILA' rtr4 ; Fq 6)et„.F N UE Oil Were all components pumped out and properly abandoned per WAC246-272A-0300? - 1 - YES 0 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 drainfield,existing and proposed buildings,location of wells,waterlines, wells.observation ports,cieanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. PPROvs• FEB 2 2 20 s a ,. MASON COU ' NTVENVIRONM ;:. .I81141 TALyEALty ARecord Drawing Attached CERTIFICATION OF INSTALLATION i 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 fo 9:nd attached Recor Drawing is accurate. form and attached Record er-wing is accurate. ., cs_.) 3 /9..z/ ' - l Signatu • of In.taller Date w Ali y r,-;... eLl v 1..°4� L i %,ter 4 . ,�tl Printed Name of Signee •`-- . '�III MASON COUNTY PUBLIC HEALTH -t00 e.A ir i,I vs.1 The undersigned approves this Installation Report and • o,t2 `. j?' ADAM J.FIUNT:R Record Drawing on behalf of Mason County Public �•. ., ' Health: •••••••••• • --S. - . t.Y..i'iNfS or,,:: w of 4 (A)\fletR\ 2_,--7.2- _. e 1 . S`na. : • Environmental Health Specialist D9te p (stamp, signature and date) --1 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 ]O«SS#d ON W5��d '� • a \ k q $ m / \$ . . n �'4. . ® 2 /zf / . 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