HomeMy WebLinkAboutSWG2024-00093 - SWG As-Built - 4/9/2024 Mason County OSS lnstaiiation Report pg.
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---- MASON COUNTY PUBLIC HEALTH
AppLl�_ 9,3 fr pP hRIT INFORMATION
ber S'r'dG�oZ (-+000g3
/t�OQKIAf/f ?alce!me Subdivision (Name/Div/Block/Lot)
res MFi� $rp ' e& A q.4�'G Installer Name Ywt'/f/ F &due.-- AV Designer Name
INS117At_4 AT;0 ,t CHECKLIST
❑ Full System Installation py Tao ., Oil, 4r.; J,7 ❑Repair ❑Other
System Type 6Qay _ deAz- —Pretreatment 1"ype_
>5 ft.from foundation? - - -- - -- - -- - - - - - - - --- -- - -- ----- 71 NIA OYES ❑ No
>50 ft.from wells? -- - ----- -- --- - ---lld -- -- -- - -- - - - - - - - - - - - - - ❑ '� ❑
2 >50 ft. from surface water? - -- - - - - -- - -- - ❑ ❑
Cleanout between building and tank? - - - - -- - -- -- -- - --- ❑ ❑
p Tank baffles present? - - - - - - - - - - - - - - - - - - .- - - - - - - ❑ Cl
a24"access risers over each compartment?- - - - - - - - - - -- ---- ❑ ❑
W M Effluent filter installed?- - - - - - - -- - - - - - - - - - - - - - - - - - - ❑ El
Septic tank capacity(working) IOOA _ -�-1 :lanufaaurer L9CAL
0 D-box water level and speed levelers used? - - - - 1 , u;A ❑ YES ❑ NO
J
O FyV
QU.
Up Manifold/0-box accessible from surface? - -- - - - - - - - - -- - - ❑ ❑
Check valvesinstalled? - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ (�
02 Transport Line Size ft 'Schadels(Class 1 t{0
Bedrooms installed (check one) - 2 ❑3 ❑a ❑ 5 ❑5 ❑Commercial/Other
>10 ft. fro!d -. .. - - - - - - - - - - - - --- - - - - -- -.. G' NIA ❑ YES NO
>100 ft. tro'rwe:ia?- - -- - -- - -- - - - --. - ❑ ❑ ❑
W >100 ft,from s.rface tvater? - - -- -- - - - - - -- - - - - - - - - - ❑ ❑ ❑
M >10 ft.from potable water lines?-- --- -- -- -- - - - ❑ ❑ ❑ i
z
a > 5ft.from property lines and easements?-- - - - - - - - - - - - - - - ❑ ❑ ❑
Ce >30 ft. from downgradient curteinrfoundadon dr Los - - - - - - - - - - ❑ ❑ ❑
Dram ield level and obse:vaticn ports present - - - ---- - - - - - - - ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (cinask -na)
Proper cover instilled over draineald?- - -- - ---- - - - - - - - -- ❑ ❑ ❑
Purrq tank setbacks consistent witn sa -tank? --_____._ - WA vEs ❑ NO
Y Pump tank capacity(flood) gal !14anufacturer
z 24"access riser(,,)snd accessible from e..:'ace°- - -- --- - --- - ❑ pry ❑ '
F
a Alarm or Ccntru!Panel Installed? - - - -- - - - - - - ---- -- - - - - ❑ ❑
Control Panel equipped with Timer/ETV 1 Ccurrar--- - -- - - - - V ❑ ❑
_ _Owl-d6m-k-A461
a Pump installed in ❑ Bucket or ❑ On B!OCn or ❑ Other
o_
-r•p_ � ,�__ t " Sotdt
g Pump Make/Modal (r.IJ� l
_ VFIOa, or El Transtlucer
:D Tank draw dawn in/min pump capacty_� __gpm Squirt Height ft
o — -
Pump on time_ --� Pump off ii r.ems_ Daily flow set ar gpd
ve�a'zumre
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic coQloo�n�rp�tp,,,aoendoone�as part of 1.^.5 pr�op1,c.:,?� - - - - - - - - - - - -- -' WYE$ ❑ No
If yes, please descd--.�^"�"-�
Were all components pumped out and property abandoned per WAC246-272A-03009 - - - - - -- YES ❑ No
RECORD DRAWING
rn:.u.,P•.. ..d.m.m n,.e.se amu.au.ns d...nPr.. .. . . "..... .. -f .Ma.,.m wtm.d...l.p.•.c. rrPKei craw
o..wrss wn .-.. Diu.e.idamextae-wr.m su,.,.s.Plel : .'. , ,. Pa.d bA.1.Jont.+..
❑ 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 actor-
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 clearediapproved by both the designer shown here have been cieered/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 fuller certify that all information contained On this I further certify that ell inibrmation contained on this
form and attached Record Drawing is acccur1atte.. (` form and attached Record Drawing is accurate.
Signature nsfeller Date
Printed Name of Signee I
MASON COUNTY PUBLIC HEALTH I
7
The undersigned approves fi is Installation Reprr. and f
Record Drawing
-on behalf of Mason C,00uun'y FubFc
Health:
i
Signature of Environmental H aitc Specialist Dan, ,'stamp: signature antl date)
rHIS FORM MAY DE SCANNED AND Ad4!V o_ FOR PUD yJ'.lE4 ON THE MASON COUNT`!WES SITE uPmw:annoia
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APpRO VED� APR
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MASONCDUNryEN4k00
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BAMFORD SEPTIC REPAIR,LLC
301 E.WALLACE KNEELAND BLVD
STE 224332
SHELTON.WA 985642M