HomeMy WebLinkAboutSWG2023-00253 - SWG As-Built - 2/23/2024 Meson County OSS Installation Report pS, 1 MASON COUNTY PUBLIC HEALTH
APPUCANTI PERMIT INFORMATION
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Permit Number 8WG 2023-00253 Parcel* 42318.50-00101 '
Applicant Name JOSEPTFI COCHRAN Subdhrisian(Name,IQivl/locklL --
Applicant Address PO BOX 117 Peg!��
City, State,Zip HOODSPORT,WA 98548 Installer Hanle ,.,,,T Rece! .�1‘
Site Address 90 N KIMTA DR Designer Name CINDY WAITED
INSTALLA' CUST ..
0 Full System Installation 0 Tank(a)Only ■Ord***onb 0 Rapatr 0 Other
Type GRAVITY Pretreatment Type
>5 ft from foundation? - ❑No ■v ❑No
)50 ft,from wells? - II ❑ ❑
>50 ft.'torn surface water?• ❑ 11 0
Cleanout between builder and tank? • - 0 ■ 0
Tank baffles present? - 0 ■ 0
24"access risers over each compartment?- 0 ■ 0
Effluent Alter Installed?. • 0 ■ ❑
Septic tank sire— 1000 _,_Aal Manufacturer EXISTING
I water level and speed levelers used? - - 0 NM II Yea 0 No
MenifoldlD•box accessible from surface?- , ❑ ■ 0
Check valves installed? . 111 ❑ ClTransport Line Site 4 Schedule/Oast SCHEDULE 3034
Badrooms installed(check one) ■3 0 3 ❑4 ❑5 Cis p Commerciallother
00 ft.from foundation?- ❑NIA U YU ❑ No
>100 ft,from wells?• - 1 II0 0
>10o It horn surface win?- ❑ II0
>10 ft,from potable water tines/- 1.,:i 2 _ [I ■ 0
>5 ft..from property lines and easements?- 4".1,/---. 0 ■ 0
Drgain1e ft dbvdowngrading
l�at curtain/foundation drains? 0 0 0
❑ Graveless chambers or ❑ Clean gravel used? (ohsok orti)-
'
Proper cover installed over drainlleld?- - 0 II (3
Pump tank setbacks omelets*with septic tank?- . 0 fie, 0 vas U ND
Pump tank size, gel Menufap4ursr
24"access deer(s)and accessible from surface?• 0 II 0
Alarm or Control Panel Installed? - s--- 0 ❑1 CI
Control Panel equipped with Timer/ETM/Counter. - - - - -=---. ❑ 0 0
.. Pump installed In ❑ Bucket or 0 On Block or 0 Other ‘Vi
Pump Make/Model ^ - 0 Floats or 0 Transducer
Tank draw down in/min Pump copaglty gpm Squirt Haight ft
Pump CO time Pump oft time Daily stow set at gptl
wwevosms
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RECORD DRAWING
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U Record Craning Attached
CERTIFICATION OF F INSTALLATION ,
INSTALLER DESIGNER'ENGINEER
I cell*that I installed the elem In scoordMnce with I that the system has been Instead in acoon,
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 Putt Health and that any deviations
here have been cleared/approved by both the designer shown here have been dewed/approved by both
and Mason County Public Health and meat all State myself and Mason County Public Health and meet all
and Mason County Codes. Stale and Mason County Codes
I higher air*that all information contained on this I tl+rther heartily that ail information contained on this
tonne -• • •Lwving is accurate, Ione and attached Record D 1,wing hr accurat -
/ i "*":7 ', 10/1319 ....,,i
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Printed Name of Signee / 4 i, ,, 'V
MASON COUNTY PUBLIC HEALTH ;F w !\\ ,h
The undersigned approve*MkthstaMatlon Roped and "~x' •wA. R hII
Record Drawingon behalf of?Jason County Public ••
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, . • Hoak SpeetsIst Dale
Warm signature and dab)
TWO FORM MAY at ewANNED ANONNIAOLE MR PUBLIC vow ON MK MASON COUNTY wee WI 41102.61 afalRAla
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