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HomeMy WebLinkAboutSWG2024-00014 - SWG As-Built - 2/14/2024 Masbn County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 20 21-1—Obcj<t ( Parcel # 3I q I I L30(X ZU Applicant Name 4e(„ { &C) . - Subdivision (Name/Div/Block/Lot) Applicant Address gact L.L C (A City, State, Zip fSk 1k n (A cigSTU Installer Name ve, Erb&r Site Address NA U £ Lk(i.4 API t�< Designer Name Dec. n HQc{-r r- INSTALLATION CHECKLIST [2 Full System Installation ZTank(s)Only ❑ Drainfield Only 0 Repair ❑Other System Type q(q,vltA Pretreatment Type >5 ft. from foundation? - - ❑ N/A ® YES ❑ NO >50 ft. from wells? - - 0 NI 0 >50 ft. from surface water? - .F i`'L 0 ® ❑ Z Cleanout between building and tank? - - 0 IN 0 o Tank baffles present? - - 0 ® 0 a24" access risers over each compartment?- - 0 NI 0 zR°l LW Effluent filter installed?- ,L�-,,r(._p0 - 0 Septic tank capacity (working) 1 5 6p( gal Manufacturer �rS CI D-box water level and speed levelers used? - 0 N/A [21 YES El NO O Manifold/D-box accessible from surface?- - ❑ a ❑ QQCheck valves installed?U- - 0 ❑ 2 Transport Line Size 1 , Schedule/Class 3 0-3 9 Bedrooms installed (check one) 0 2 D3 04 0 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A ® YES ❑ NO CI >100 ft. from wells? - - 0 Sr 0 Li! >100 ft. from surface water? - - 0 ® ❑ ti >10 ft. from potable water lines?- - 0 ® 0 er. > 5 ft. from property lines and easements? 0 ® 0 > 30 ft. from downgradient curtain/foundation drains? - - 0 12 0 Drainfield level and observation ports present - - ❑ ® 0 14 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 Si 0 Pump tank setbacks consistent with septic tank? - -t, 0 N/A 2 YES El NO 11 'L u24-1- I'-1 II Y� Pump tank capacity (flood) 1250 gal Manufacturer Z 24"access riser(s) and accessible from surface?- - 0 51 0 a. Alarm or Control Panel Installed? - - ❑ ar ❑ 2 Control Panel equipped with Timer/ ETM/ Counter- - 0 2 0 m d Pump installed in Et Bucket or ❑ On Block or ❑ Other a PumpMake/Model 2.d110 t: I S3 Floats or 0 Transducer a Tank draw down lv(� in/min Pump capacity �(!SO / gpm Squirt Height NfTp ft Pump on time NA-A- Pump off time 'V A A!Daily flow set at Jr /4 gpd Updated 8 2t,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: OJe Sher) [Cw►� Sy � �Y� {nor USG pn CwrisG houS•e.- Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES E. 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 drainfeld existr'g and proposed buildings bcat.on of wells,waterlines. wells.observation ports cleanouts and ether ma ntenance access points. Incomplete Record Drawings may create add tonal delays in final installation approval and related permits. 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 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 form and attached Record Drawing is accurate. form and attached Record ing is accurate. Sifrloe of Installer Date r • 1�l Printed Name of Signee MASON COUNTY PUBLIC HEALTH ^ : r • The undersigned approves this Installation Report and ' StLoTh; HU ' , � ADAM J.NUN7ER Record Drawing on behalf of Mason County Public 'L'nt'��t�tjric `�l t� Health: / u.i°,,:C: u;;,_, 2L( 7) 2 �6 H f2' Signature of Environmental 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 212018 I k 000000000 l mm X X X X isi mm mm fmit X X p Ws' n 13 -1 -i Co -I -I -1 G) p F, O V 0 CA y Z n `= mz O m r xz gO m73 m m > o . ©in p m r > p ppONuIn $ to Z S ) pm _ Z. 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