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HomeMy WebLinkAboutSWG2021-00520 - SWG As-Built - 3/11/2024 (2) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Peril Number SWG2024 -00V-T-C Parcel# Ze2zys eo M Applicant Name iG„ DclQ,,,i Subdivision(Name/Div/BIocWLot) F `Z Applicant Address 2424 S� ee, LP AD Nr) FB �1p24 City,State, Zip „f Sp_T-pz Installer Name C VF Site Address D 134 f E crL�flnk� Designer Name �./ INSTALLATION CHECKLIST L/J Full System Installation ❑Tank(s)only ❑Drainfield only ❑Repair ❑Other System Type Q! sf � 9?n!!�t ti. Pretreatment Type /a�Y >5 ft.frown foundation? --------------------------- ❑WA DEs ❑No >50 ft.from"Us? ------------------------------ ❑ ❑ Z >60 ft.from surface watw? - ❑ El fCiearlout between building and tank? ----------- ----- ❑ ❑ O Tank baffles present? -- ------------------------- ❑ Er ❑ O~. 24"aocess dsers overeach compartment?---------------. ❑ El NEffluent filter installed?---------------------------- ❑ ❑ Septic tank capacity(working) / 'Z sal Manuketum D-box water level and speed levelers used? -------- wA ❑vEs ❑ xo O0 Manifold/D-bmc accessible from surface?---------- ❑ �/ ❑ GiCheck valves installed? -------------------------- ❑ d Eli Transport Line Size -2 " 9yuduls/Cysa ic/a Kd Bedrooms installed(check one) ❑2 0 . ET4 ❑6 ❑6 ❑CommerclaVother >10It.from foundation?-- ------------------------ ❑ WA gls NO G >100 ft.from wells?---- ------------------------- ❑ (2" ❑ W >100 ft.from surface water?- ❑ ❑ ir Z >10ft.from potable water lines?------- - , ❑ ❑/ ❑ >5ft.from property lines and easements?---------------- ❑ ❑ >30ft.from downgradient artainlfoundation drains?---------- ❑ Dmt eId level and observation ports present -------------- ❑ ❑ Greveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?----------- -------- ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?------ ------- ❑ WA L'Js ❑ No ZPump tank capacity(flood) C fo at Manufacturer F/saa'_tres..aJ 24°access nser(s)and accesslNe from surface?-----------_. ❑ ❑ fl Alarm or Control Panel Installed?-------------------- - ❑ ❑ Control Panel equipped Timer I ETM/Counter----------- ❑ ❑ IL Pump installed in Bucket or ❑ On Block or ❑ Other LL Pum Make/Model L,2,etn � P T=t-ch L,i Floats or ❑Transducer 6. Tank draw down Irdmin Pump ce paclty apm Squid Height ft Pump on time Pumpofttime Dal= set at apd wd. not . i Mason County OSS Installation Report pg. 2 Parcel# --3J.v 2't-(2-�evzp ABANDONMENT RECORD Were mmtmg septic components abandoned as part of this project? ---------_-_--. El yes No If yes,please describe: Were all components pumped out and properly abandoned per WAC2462/2A-o300? -------- AYES No RECORD DRAWING mn a.n.w.wn w.we.tee m..l a....m..°a oawi,a.wome a..enme a m.°vae moment°a Teruo xe.'aw°a mee mwoen.amn s.ow.w.�°aea�°a.w...w^e•m e�cweawiN'm.wwe.°.l.ai.,waeaea wyle.Mwvellm�L[tleenwla,aW Naa mainlrmw eovu p.mK lrvsmrygy gamrE pmringi-1 wale WLrwW dp AMd n �.urnaepea amm.i.e wm:e. aPPRQ V " MAR 1 12024 W'�ON COUNTY ENVIRONMEN7gL Jaw / 0-9R ad Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER]ENGINEER I comfy 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 deviab'ons shown Mason County Public Health and met any de Nations here have been cleafed/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 car*that all information Wnlained on this I further certify]hat all information contained on this form an10'm.�,Ier ad Record Drawing is accurate. form and attached Record Dmmngis accurate. / Y Sg b, Date •.t _ ,Tent P cvtJ Pnntsd Name of Sigma 5 MASON COUNTY PUBLIC HEALTH The understgned approves this Instatlaton Report and Rec M htgonbeheffofMsspo CouhIyPuW 4He A S/gnat p mantel Health spadaliat Data (stamp,signature and date) THIS FORM MAY BE SCANNED AIO AVARASLE PCA PUBLIC VIEW ON THE MASON COUNTY WEB SITE l�w.�.en+rzo+s i i i � | i B i § � ��^ .... i r i Om i \ � � - i k i § _ ` i \ d i k % , ! ® i i2 ij i ! ! 7 ; ' 0 | § § \ | § § > 0>- P z Q \� § / \ � ) � r „ m # i n @ , ; ■ ■ ■ : . , � ;) \ : & ere22 \ § o o Og J , P ` p = � , % / J § - )! ; - $ ! 7ƒ ` § © P § ) ! ( § § / � , 2 ' 5 ) z } \ / % 3 § § _ _ «L . \ \ zm _ ( ) k \ \ / ) , \ \ � _ , ; | | | ! § � � &ic M ) d k / f | ! 0 z a § % t § Chik ( � § ) � k7 \ \ � w ■ - - , © k !kz 0 \ 9 E ! La § k ! ^\ & |! § - 2 �0, \ � w 0 R 0 02 ' z , 00 > } og.zoz ui x mac ) § ; \ k &kf. - � � \ Ogg§ \ \- � j \ i \ w \ | i } ou i i 5w 0 ui ly - | i � 6 | ; ' | }] (