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HomeMy WebLinkAboutSWG2021-00520 - SWG As-Built - 3/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT!PERMIT INFORMATION Permit Number SWG 2_.5-tl _oar Parcel# Applicant Name , Subdivision (Name/Div/Block/LOt) FFe Applicant Address 2r.zq Sck , ✓. LP Ao NJ 3Z0T4 City,State,Zip Dfghn' p V7- Installer Name �gttf C Site Address r?G r P r1WV&!4v Designer Name INSTALLATION CHECKLIST Ll�FWI System Installation ❑Tenk(s)ONy ❑D2infield Only ❑Repair ❑Omer System Type Pretreatment Type µl( >5ft.from foundation? --------------------------- ❑NIA D'95 NO >50R from were? ------------------------------ ❑ ❑ a >SOR from surface water? -----------------s ------ ❑ r[r ❑ H Cleanout between building and tank? ------------------- ❑ []— ❑ L) Tank baffles present? --------------------------- ❑ 0— ❑ 1-- 24"access risers over each comportment?.-------------- - ❑ 0- ❑ WEffluent filter installed?.------------------------- - ❑ ❑ rn Septic tank capacity(worktng) ! �-�D oat Manufacturer o D-box water level and speed levelers used? -------------- - NIA ❑ves ON, O0 Manifold/D-box accessible from surface?---------------- - ❑ (✓ ❑ fQ= Check valves installed? -------------------------- ❑ [� ❑ G2 Transport Line Sim Z `1 Schedule/Class SoI.. ` 1p Bedrooms installed(check one) ❑2 [3 . 4 ❑5 ❑s ❑CommemlaVOlher >10ft.from foundation?-------------------------- ❑ NIA [}4M5 ❑ NO >100 ft.from wells?----------------------------- ❑ [y ❑ or >100ft.from surface water?------------------------ ❑ ❑ lL >10ft.from potable water lines?---------------------- ❑ 111 ❑ Z >5ft.from property lines and easements?---------------- ❑ Ld ❑ Q >30It.from downgradient curtain/roundation drains?---------- ❑ —❑"/ ❑ Drat eld level and observation ports present-------------- ❑ L� ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ ,,❑,,// ❑ Pump tank setbacks consistent with septic tank?------------- ❑ NrA Lryas ❑ No ZPump tank capacity(flood) r3f" oat Manufacturer oLa 'z+•--•-' H24"access dser(s)and accessiblefrom surface?------------- ❑ [� ❑ a Alarm or Control Panel Installed?-------------------- - ❑ [r - ❑ 2 Control Panel equipped . Tmer/ETM/Counter----------- ❑ � 1-1IL Pump installed in Bucket or ❑ On Block or ❑ Other --// gPump Make/Modei L�'Ct� m �7Floaie or ❑Transducer IL Tank draw down in/min Pump rapaGly lam Squirt HeW h Pump on time Pump off time Daily flaw set at apd tpa+relavmfe Mason County OSS Installation Report pg.2 Parcel# ABANDONMENT RECORD were ewsting septic components abandoned as pan of this protect? ---__-__-----_- yE3 NO It yes,please describe: Were all components pumped out and property abandoned per WAC246-272A-030D? -- ❑� RO RECORD DRAWING Tx�.N.r�nwn�«o.a..a reo.r a..�wm w a..�cao mmusn m nmmm m w.we a mm�m.,...acmMM.mH nwna..tlwmmc Trod a.�e ora.+ro+m.mo:u.irresm.moua;.m.�nam�t s.nmwreom.xemmn.aan.�rcw.n.n.eremmm...;wre..e erev�+emv�Ys.mee�or.di....mm.ea wtllv.oNMvetlm WK tl0erou4 W aIM1N��MMnim M'M.ramm. Imn�q�^�ngruNOrwN9ID neYm<6m W]1MfIMlfi'.N fiad IrtWtiY�eR.avNaN felelal Po�� APPROV MAR I I r. ^�asoN coumn emvlltoNMeNral°ew r Jaw l�ala aettlonpAnaatel! CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI ENGINEER I certify that I installed the system in attendance with I cerdh'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 aid that any deviations here have been Geared/approved by both the designer shown here have been Gearediapproved by both and Mason County Public Health and meet all State myse fend Mason CountyPub6c Health and meet all and Mason County Codes. State and Mason County Codes i further certify that all Nfonnation contained on I further candy Van all iolmmation contained on this form antl eftac ted Record Drawing is accurate. form and attached Record DraWngis acuurate. / Date Sig m oflostaller Date g:+ Punted Name ofSignee `e ti cr4. F MASON COUNTY PUBLIC HEALTH W laau,:y d.Rrc er The undersigned approves this installation.Report and ttt Race m ing on behalf of Mason County Public V ,, He h: o mantel Health Specialist Data (stamp,signature and date) THIS FORM MAYBE SCANNEDANDAVAtIABLE FOR PUSUc%it WONTHEMASONCOU?M`i?®SITE Ummeaavm+° § [\ e « ® — � i � | � | � / m ! i ; 2 � [ i m � § i ! _ i ( � i : \ - \ \ 0 ! 7 , $ � e i 2 � ( Cm rn ® 9 ° ! $ / X � M q 2 ( 0 m \§\ \) 2 ~ ƒ � § / ; > , _ � Q � § ; \ > | e ! i v \{ Q § / § ( ■ / } , z» ;; - , $ , , , , « * oo k� \ \\ § 2z D ` %r ) | | ; ` _ § i i i i co § § i ) k � � � � i . � -j , [ § i 2 m � k� - m | m § 0 ci § § 0 xi k § / ) | � . .. i i � i7 i ! � m % ( « \ k { i Vic:: i . § § gM , � ; � ! § ! (\ dk2 ` ` � , ® 0 ■ ; , : ■ § & �g ! ® ee; E7E \ $ Q y n ( § , . . = = * P` P= ` L ; : ! ( ` )( \ § /\ /) §( j - ^ �ow FS § ) . ) ®: m ; z 2 Je f* ■ © \ \ \2' n - ° » p E )° \ ' ( / & 20 \ _ \ 04 > : . e § § § ! 0 , z � n