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HomeMy WebLinkAboutSWG2021-00097 - SWG As-Built - 3/21/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION /� Permit Number SWG WZ/ �047 Parcel # �j1� 3(91�o01�JN Applicant Name Oav"do f rM//rj 6�in •Tfti, Subdivision (Name/Div/Block/Lot) Applicant Address r0 Ay 1)3Z J j City, State, Zip freefi ,/ f4 l y V f Installer Name C%'1/ j,,eSrvlG'fl . Site Address 13A, W MAuid`1' ek f L Designer Name (Aril tiS f c0t/ INSTALLATION CHECKLIST XFull System Installation ❑Tank(s)Only ❑ Draintield Only ❑ Repair ❑Other System Type9rhP4 posstiftf, kevf kW! ICAA Pretreatment Type P/A- >5 ft. from foundation? - - ❑ N/A RYES ❑ NO >50 ft. from wells? - •- 0 RI 0 Z >50 ft. from surface water? - - 0 (Xf 0 H Cleanout between building and tank? - 0 [ 0 U Tank baffles present? - - ❑ E 0 d24"access risers over each compartment?- - ❑ 'fit' El W Effluent filter installed?- El '14 0 N Septic tank size PO gal Manufacturer Xen9,5 5 D-box water level and speed levelers used? - 10 N/A 0 YES ❑ NO o4 Manifold/D-box accessible from surface?- - ❑ MI ❑ u. 99" Check valves installed? - - RR❑ NI 0 Transport Line Size Z it Schedule/Class LU Bedrooms Installed (check one) ❑ 2 ❑ 3 0 4 ❑ 5 ❑6 [ Commercial/Other >10 ft. from foundation?- - ❑ N/A MI YES ❑ NO CI >100 ft. from wells?- . ❑ 1iz 0 W >100 ft. from surface water? - - ❑ (V 0 ti, >10 ft. from potable water lines?- - 0 ® 0 el > 5 ft. from property lines and easements?• - 0 tI 0 12 > 30 ft. from downgradient curtain/foundation drains? - ❑ ® ❑ cl Drainfield level and observation ports present . - ❑ IX ❑ ❑ Graveless chambers or gat Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 [Z' 0 ~ Pump tank setbacks consistent with septic tank?• • ❑ N/A Z YES ❑ NO • Pump tank size Sad gal Manufacturer kyles - Q24"access riser(s)and accessible from surface?- - [r ricle ❑ H a Alarm or Control Panel Installed? - - P3S ❑ 2 Control Panel equipped with Timer/ETM/Counter- - CI ❑ 0- Pump installed in ❑ Bucket or ❑ On Block or 14 Other 0/�C$ttn �?101ak b0it 0 ti Pump Make/Model Vela Oo?F i [Floats or ElTransducer '/ N d Tank draw down !Z in/min Pump capacity 00 gpm Squirt Height ft r Pump on time I� t5,111 Pump off time ), S firs Daily flow set at ago gpd ox Upda led 8/21/2018 4 Mason County SASS Installation Report pg. 2 Parcel# b1q !3oOc7/O �� ABANDONMENT RECORD , Were existing septic components abandoned as part of this project? - - YES rzirNO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES l/A, cj NO RECORD DRAWING This fs a permanent record and must be accurate end descriptive enough to re-looate In the need of maintenance activities and future development. Typical Record Drawings contain: Drainfleld&manifold orientation&layout,Septic/pump lank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterines. wells.observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays In final installation approval and related permits. Sw Aoper� 1 6esjr ' 441I V � APPROVE 0 v E . . MAR 2 0 2024 • 0 COUNTvCNvi :; a/e w MENTAL HEALTh E Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I Installed the system in accordance with 1 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 Cot my Codes. State and Mason County Codes I furl i certi that all i t'ormation contained on this I further certify that all information contained on this for ,a + ed cord Drawing is accurate. form and attached Record Drawing is accurate. fgnatu^r'e of Installer 514 Date a-. L Printed Name of Slgnee �� MASON COUNTY PUBLIC HEALTH y � g. �` tr The undersigned approves this Installation Report and �, 508 3 Record Drawing on behalf of Mason County Public �t�` g Health �!'�� OS�� ��•..•'� ONA1. � nAh. 3-.2l.-gy 3 -Z�i Signal re vironmental Health Specialist Date J , (siamp,._44 sand date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 821/2018 • • r -- N., am. SG.l ivvE AF.tk .FAO } li• • • iti ,t o \ 3 Ii • F \ • oW, v D R Q 11 ( the a , r i/ \ W i 0 0 0o v F. \\ I I `� 'M1 • n h ' y D ii. < .c.,risn vG l7 i k to` ti 40\: -_...i V. __.. \ \ N Z !. wor = • — v._________:::16 1 . s'/Agy) j....... \...... ____ ' --- N \' p w 11 \ �(� �� 1 r F, y z • � - �� -' 1 \ ! i1 Z m \ `` 1 "� ` ' ° 6") M emu .\ • 81 , O \ i 1 i '. i N - . 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