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HomeMy WebLinkAboutSWG2023-00290 - SWG As-Built - 1/29/2024 t eY Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION . Permit Number SWG 2 a .2-3_ 6(-,2 qD Parcel # Z2-1 Z7 -5 6 -- O 1 Q 21 Applicant Name ip.UY ' . &- /TWA 9..00eVtSSubdivision (Name/Div/Block/Lot) Applicant Address \ J lY6 `1 City, State, Zip CIVUpPV IP In 4 U Q14ia Installer Name woes Rawafing t ,pI,t Site Address 1 gO F. (IYG raki(4 WIX,l •Designer Name INSTALLATION CHECKLIST Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type &5 c,( X L. Z_ Pretreatment Type >5 ft. from foundation? - ❑ N/A [Gf Yes ❑ NO >50 ft. from wells? - •- 0 In 0 Z >50 ft. from surface water? - \ - ID H Cleanout between building and tank? - --- g• C.) Tank baffles present? - � Ela 24"access risers over each compartment?-Titi-$a_L V -tj _ - ❑ W Effluent filter installed?- C3 El en 0 Er CI Septic tank capacity(working) 17-00 g anufacturer 2 v A-IN 0 D-box water level and speed levelers used? - - El N/A El YES El NO mu. O Manifold/D-box accessible from surface?- - El ❑ CI Check valves installed? - - 0 0 0 2 Transport Line Size Schedule/Class Bedrooms installed (check one) Ed; 0 3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft.from foundation? - - - N/A VJ YES ❑ NO C >100 ft.from wells?- _ - 0- -- 0 ❑ W >100 ft. from surface water? - _ -- - - 0 Z >10 ft.from potable water lines?- - -- - _ FS.B L i_2024.__ CD ❑ > 5 ft.from property lines and easemeritg,$QNG 4T-VENA/ReAtEid-TALK ALITil El> 30 ft.from downgradient curtain/foundation drains?JB4 _- - - - - ID cel Drainfield level and observation ports present - - Er �.,-,/ El ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 Er--- ❑ Pump tank setbacks consistent with septic tank? - - 0 N/A ❑ YES ❑ NO Pump tank capacity (flood) ) Z°v gal Manufacturer 1Z a 1. Z < 24"access riser(s)and accessible from surface?- - - - - - . -- ❑ El F- a. Alarm or Control Panel Installed? - - 0 0 ❑ 2 Control Panel equipped with Timer/ ETM/Counter 0 ®' 0 M n- Pump installed in ❑ Bucket or EliOn Block or ❑ Other 11. Pump Make/Model 6 G 2 il- ❑ Floats or El Transducer Q. Tank draw down in/min Pumpcapacity Q. P y gpm Squirt Height ft Pump on time Pump off time Daily flow set at L U gpd e- G y/mil f Fitt- f- / f uP �eee121noia �"/ P �C tom- ��ffar.c cat ew Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG Parcel # ZZ' Applicant Name (,atJn'e �Z'] -5 b � d � d 2� 2 � /fft01 eYtSSubdivision (Name/Div/Block/Lot) Applicant Address \ :Jn G otayiy6 Cat City, State, Zip C: pev ie uJ 4 I (465(1 o Installer Name �� �0te5 ���'U�'n1 t �'pH�' Site Address Lei() E nY(.thy A een0/\Designer Name Er INSTALLATION CHECKLIST LJ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other System Type &5c..c( xv Z Pretreatment Type >5 ft. from foundation? - >50 ft. from wells? - ❑ N/A �YEs ❑ NO >50 ft. from surface water? - 0 ❑ E ❑ Cleanout between building and tank? - - 0g. V Tank baffles present? - - ❑ I` 24"access risers over each compartment?- ❑ or,,, 0 IL Ngal Manufacturer Effluent filter installed?- 0 0 Septic tank capacity (working) I Z G 0 /❑v �/'‘ 0 0 D-box water level and speed levelers used? - OO Manifold/D-box accessible from surface?- N/A ❑ YES ❑ NO CQ Check valves installed? - -- a El 0 2 Transport Line Size ❑ ❑ Schedule/Class Bedrooms installed (check one) ' 2p 3 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - '; _ _ _- G >100 ft. from wells?- i __ ti _ ❑ NSA YES ❑ NO r! -.1 >100 ft. from surface water? - _ �E� uQ24 - _ ❑ ❑ COLiNTV ice - ❑ M ❑ LT. >10 ft.from potable water lines?- Di ENYI&g _ ❑ 0 iviAQ > 5 ft.from property lines and easements?- -JRi j �HEAL - ❑ Er >30 ft. from downgradient curtain/foundation drains?- ❑ 0 G cEi Drainfield level and observation ports present - • - ❑ 172/ ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- _ 0 r3----- 0 Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES 0 NO ZPump tank capacity (flood) ) Z."v gal Manufacturer IZ a f < 24"access riser(s)and accessible from surface?- - -- - - _ - - -- ❑ E2 ❑ a Alarm or Control Panel Installed? - 0 El Control Panel equipped with Timer/ETM/Counter- - ❑ ®. ❑ d Pump installed in ❑ Bucket or tfOn Block or El • Pump Make/Model r E2�- ❑ 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 L `i D gpd Updated 8/21/2018 rmmeir Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - OYES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES ED 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 drainfieid,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. • 4PPROVE aE& 01024 • "S COUNTY ENVIRONMENTAL HEALTH JBW 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 !further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. IllM123 air1 Signature of Installer Date i 1 * Printed Name of Signee Py . •, 'o to f� to )v MASON COUNTY PUBLIC HEALTH 10118 The undersigned approves this Installation Report and O Y3 WAITE�\��11� Record Drawing on behalf of Mason County Public Zoom i LICENSED DESIGNER � H th:\ EXPIRES 05,10r ./ Sign r o E/vironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 a * if a N P 9 � 0 1 ai,n P `// • �. - !!) 12 A: �r a $ ! . h I � dw V s. �.V w•.,, ��� St,� �. e I� °Al 3 ' lio i.EX,..KLS oS,IOW I\ �� Ob:' " \ems�\6 +a O -.."' "71 .... • • . \ A, ,./.. .. 0411, (4./.:44 , \ * - Aeiiiit_i 4/ u i:: :drlirr.,• •• \ k t / ° °qn y4s (. © tg , •1 G O ?...... ` tf N 0 ' & t 4-- V w y o I } ,� 4 ' q'• 1 t1 S 1... ... .'/ 0 'Ret .....„....... 1. ia Ci L� 4 Ai\itti ;� o - r� „q,,.. a ... ..zie ..4,.. yr APPROVED� .116 2024 $ �. ,,�' .i "Q A : t ",: 44 Ph MASON.COUNTY ENVIRONMENTAL HEALTH t LBW