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Home My WebLink AboutSWG2023-00534 - SWG As-Built - 3/11/2024 CLEAR FORM Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH ;>! APPLICANT/ PERMIT INFORMATION Permit Number SWG 2 27-5—ooS34 Parcel # 31g045300ao 1 Applicant Name Faw.ir. Lg14 J►Aa44-ow►nte coMSubdivision (Name/Div/Block/Lot) Applicant Address 411 SE (..rtstea,4- fl,r Fciwvn Lett - Cabana. City, State, Zip 5VKA4apl W•. ellbSt 4 Installer Name wi. wj gxccoleti-ine3 tic Site Address 7.20 SE C,ccba,,.k Ave Designer Name Cwil .y V%)ai4-t INSTALLATION CHECKLIST El Full System Installation ( Tank(s) Only .0 Drainfield Only [IIf Repair ❑Other System Type Gvav:j Pretreatment Type >5 ft. from foundation? - - [iN/A ❑YES ❑ NO >50 ft. from wells? - - ❑ Nj ❑ Z >50 ft. from surface water? - - ID MA ❑ • Cleanout between building and tank? - - ❑ [Jf ❑ o Tank baffles present? - - ❑ [� ❑ Ia 24" access risers over each compartment?- - 0 44 ❑ W Effluent filter installed?- - ❑ NJ ❑ Septic tank capacity (working) i'S OO gal Manufacturer VAel&Ymctrl fvt-(h54- 0 D-box water level and speed levelers used? - - ❑ N/A >R-etrro [M"YES El NO �O Manifold/D-box accessible from surface?`: - ❑ ti+cin 0 mZ Check valves installed? - - lg ❑ ❑ oa 2 Transport Line Size 4" Schedule/Class 30204- Bedrooms installed (check one) ❑ 2 ❑3 CI4 ❑ 5 CI6 Commercial/Other >10 ft. from foundation? N/A ❑ YES ❑ NO >100 ft. from wells? - 0 Ef CI —> >100 ft. from surface water? M - CI [ CIL.T. >10 ft. from potable water lines?- AA� - ❑ 0 Z > 5 ft. from property lines and easements?- - - - - - ❑ l CIQ ixc, d CI> 30 ft. from downgradient curtain/foundation drains? - - - - - - - Drainfield level and observation ports present - e ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - le ❑ ❑ Pu • • tank setb-.• - consistent wit epic tank?-- - - - - - - - - - • /A ❑ Y : El NO 'U • tank .paci , (flood) '.al Manufacturer I; 24" acce . riser(- and accessible from surface'?- - - - - - ❑ ■ E Al:rm • Contr. Panel In- ailed? ❑ ❑ ■ E •on of Panel -quippe. with Timer/ 'TM / ' ounter- - - - - - - - - ❑ 0 ■ D a ' .mp install:d in rA Bucket or ❑ •n Block or ❑ • her n'• Pump Make/ ..::el _ CI Fir or ❑ T . -•ucer 0. a Tank draw down in/min Pump capacity gpm Squirt Height, ft Pump on time Pump off time Daily flow set at ••d Updated 8/21/2018 • Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES El NO If yes, please describe: / Were all components pumped out and properly abandoned per WAC246-272A-0300? - - [�l] YES 0 NO RECORD DRAWING This is a permanent record and must be accurate and descriptive.enough to relocate 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,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. f ['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 Drawing is accurate. Signature of Installer Date +3YCAV4tel `. C..V•be.fotti Printed Narf�e of Signee J MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: C LINWKIM i 1 .1 ( " 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 82t2018 RECORD DRAWING (continued) Jr K)W,, ELS 04- Mcvid. 2-o24'. Oval ti\nswip., wcts AiNL.. Atm, i-«.htL locmM.►. 1 ridwel1;a. yin a.-12eI_ Vxa:vS4<1l v.70.5 �x►4A 1AAA CAN ;AN A. 01. 4-0.k14. it,sAallak4ob.. Nu..",-, ti.ova. 's kolaktir ,&,V:VAtzs All ovI'Y c.v. sre,. 4_ ',p I ,} Vc • i I Y.yt.€s v a,tcji�' f QktY1iC) r'1 t-loox ve...k-vbciAel ho' to' l / (i)4" kvar.�si01'4 V So' J dirt • O : ( U-- at" .-tQY1 VA- l to O-box 1 LJV-.x‘s+:w'(a) too° T.I funks Lovwsvtili►oink,1 I ID 6" woks-0..4;Y. i V Ck-tc v►o-.A- 1 t i 1 v.. i -17 1 •. Lug 3 :D I _..