The URL can be used to link to this page

Home My WebLink AboutSWG2022-00539 - SWG As-Built - 4/3/2024 Mason County OSS Installation Report pg, t MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG J02,� —005—?? Parcel# Applicant Name 14///�Ae,-u Subdivision (N ame/DivlBlock/Lot) Applicant Address 670 City, State, Zip %6c„ .,,� �,a 9 �'Y`7 Installer Name /_�an/fi zf-Lr.,A7L/�24 Site Address 9so C %r1a.,$) �l, �6esignerNam INSTALLATION CHECKLIST -Full System Installation ❑Tank(s)Only ❑Drainfield Only ,�1 ❑ 1A epair ❑Other R 0 System Type .San P� 26Wikegietrealment Type O 1'f Z >5 ft.from foundation? •--------- ----------- --- --- Zj N/A ❑YES >50ft.from wells? - ------------ - ----- ----- - - --- I ❑ ® ❑ Y >50ft.from surface water? - -- --- - - - - - - - - ---- z _it l I❑ H ❑ Cleanout between building and tank? - - --- -- - ----------- ',❑ 9 ❑ r, Tankbatflespresent? -- ---------- - -- - - ---- -- - - -- ❑ 49 ❑ a24'access risers over each compartment?--- -- ---- ---- - -- ❑ �J ❑ w Effluent filter installed?. ------ - ----- -- - -- - - -- - - - -- ❑ rrl Septic tank capacity(working) ^/ 2Vj2 oar Manufacturer -'e �� P 0 D-box water level and speed levelers used? -- -- --- -- -- ---- 0-NIA ❑YES ❑ No 00 Manifold/)-box accessible from surface?- -- --- -- - -- -- ---- ❑ ❑ a?z Check valves installed? ---- a ❑ ❑ OQ A ea 2 Transport Une Size Inch SchedulelClass Bedrooms installed (check one) ❑ 2 ❑3 19A ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-------------------------- &WA ❑ YES NO G >100 ft. from wells?----------------------------- ❑ 49 ❑ W >100 ft.from surface water9 ------------------------ ❑ 19 El iZ soft.from potable water lines?---------------------- ❑ N ❑ Q_ > 5ft.from property lines and easements?- --------------- ❑ ❑ K > 30 ft.from downgradient curtain/foundation drain?---------- ❑ (XI- - ❑ Drainfield level and observation ports present --- -- ❑ ,® ❑ ❑ Graveless chambers or JR-Clean gravel used? (Chock ate) Proper cover installed over drainfield?--- ---------------- ❑ ,� ❑ Pump tank setbacks consistent with septic tank?------------- bNIA RYES ❑ No Y Pump tank capacity(flood) c--Oo at Markdechrer u m - Q24'access riser(s) and accessible from surface?------------- ❑ .� ❑ ~ Alarm or Control Panel Installed? -- ---- --- ------------ ❑ ❑ a jControl Panel equipped with Timer/ETMICounter- -- -------- ❑ � ❑ 0- Pump installed in ❑ Bucket or ,®-An Blocck, or ❑ Other Pump Make/Model% l�d [-Floats or ❑ Transducer a Tank draw down in/min Pump capacity dpm Squirt Height ft Pump on bme Pump off time I Daily flow set at dpd %19J f'Ow eK. 0 Nl !I uw. wim,s Mason County OSS Installation Report pg. 2 Parcel ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - ----- ------- ❑ YES ❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A ----- -- ❑ YES ❑ NO RECORD DRAWING mlra ra a palmaand nenm and nand to anutafa and dacdouve enough to n-lacaa In Na need a Man, mrda me ,,aa and iNan Mveloaaant Typk RecMd Drawma cdoddn'. pri A nenlaa odentaxin b teynd.sepea"dip rank bmYon.NO orm.nemaM "Sum and popoeM WJEnga.WdOw of xalk,"dnna. xella,pdeMtlon pole,tleanolN,eM ONameNlen Aatlxae poNN. IMEmplaaR MoraxNpemay adidarai dNrye In Ma Wwinuon epixtval W nra@E paMY. pPY. c�PrI'gA) &> 'f oC (Va l ye Ba, L L 'd; 'UPI usrJ, I -45Ae t- henw Power. /s oNrile f'*P -fir la.-A , 77,9,.E 1 Al I qRecord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER[E MGINEEIR 1 certify that I installed the system in accordance with l certify that thn P system has been installed in accor- the septic design stamped'A PPRO VED"by Mason dance with the septic design stamped'APPROVED"by County Public Health and that any deviations shown Mason Coun Public Health and that any deviations here have been clearedlapproved by both the designer shown here h ve been cfeared/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 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. i nature or Installer Date her a t� Printed Name of Signee 1 MASON COUNTY PUBLIC HEALTH 100418 Q DY E.WN The undersigned approves this Installation Report and LICENSED DESIGNER Record Drawing on behalf of Mason County Public Lxpwts m,a ' Signature ofEnv7�n Health Specialist Date stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON JHE MASON COUNTY WEB SITE updated&ttReta .�.rec �7a9♦ `/ `J 6 •ti sr•,.� Pl.>f X� �-z-r,�� LAkP Ror 9:. .A2 g2Qpl f APPROVED R NOY 0 4 2022 r 1v VSGN000NV Li C,40y YI E �� r � Q lKEN9ED DE8N NER //l.IM rt alvl / / oycpvy�F 37 , �G por<<J r1y, /9oca9� qoy o1y 4r' r z oo q a/AN yW� ` %yap 4 0Y �19Li� qW L av'J" /stsv4 11Pfw L C� Pro pot-j w. li ;`. ,< „ _ 10� II �r v.0 T F-Y i{ �i ✓P l3 ail / Its Printed R&M MWs0p-Q@unty DMS IY 8wl l r,1j Printed from Mason County OMS 3ij v�