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HomeMy WebLinkAboutSWG2022-00032 - SWG As-Built - 5/29/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number sw(3 2- 032 Parcel# y221 toSoo of d Applicant Name ,L C Subdivision (Name/Div/Block/Lot) Applicant Address D 2 City, State, Zip v,,R $ Installer Name •f Erb I+ncr Site AddressI50 lL ,,ptLA� Designer Name A;312 EL INSTALLATION CiHECKLIST ' Full System Installatio ❑Tank(s)Only ❑ Dralnfleld Only ❑Repair ❑Other System Type - - Pretreatment Type >5ft.from foundation? ---------- -- - -- ------ ----- ❑ NIA D-<s ❑ No >50 ft.from wells? - - -- - ------ - - -- -- -- -------'- ❑ ©- ❑ Y >50ft.from surface we ter? - --- - ----- ------ - ❑ 1q' ❑ Z El 2- Elha- Cleanout between building and tank? ------- ----------- - tl Tank baffles present? - ---------- ----- --- -- -- ---- ❑ 0' ❑ H 24"access risers over ach compartment?-- -- --- ---- ---- - ❑ 9— ❑ (L W Effluent filter installed?-- ------- - ----- ------ ------ ❑ a- ❑ U) Septic tank capacity(v orking) 19U0 gal Manufacturer °ou VD �Pp` mrY1GQJ _0 D-box water level and peed levelers used? - - -- D "'^ ❑YES ❑ No O0 Manifold/Dbox accesElble from.surface? - -- - -- [� ❑ ❑ mz; Check valves installed. --- -- --- -- --- ❑ ❑- ❑ Oq M Transport Line Size 2" ,-,! Schedule/Class I-f0 " Bedrooms installed(check one) L"J 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-------------- -- -- -- ------- ❑ NIA IT-ES ❑ No ... >100 ft.from wells?-1-- -- --- ---- ---- ---- ❑ � ❑ d1, >100 ft. from surface water? --- - - - -- --- - ❑ [� ❑ a: >10 ft.from potable waterlines?----- --- -- ❑ I� ❑ Z >5 ft.from property Hi�les and easements? --- _ ❑ []' ❑ >30 ft.from downgrac(iant curtain/foundation drains?- - ❑ [ ❑ Drainfieid level and cb ervation ports present - -- -- - - ❑ [� ❑ ❑ Graveless chambers or []'Clean gravel used? (check one) Proper cover installed'laver dralnfeld?-- ------------ ---- - ❑ [l� ❑ Pump tank setbacks c,nsistent with septic tank? -- ---- ---- -- - ❑ NIA a'YES ❑ No .Y..Pump tank capacity fill od) 12oc> gal Manufacturer So�rvll 2LKt2Evl1t�i'T Q24"access riser(s) LD"6nBlock rom surface?--------- -- ❑ [✓� ❑ F+ --sa , Alarm or Control Pa -- - - -- ----- ----- --- - ❑ ❑ � .Control Panel equlpETM/Counter- -- -- - - - -- - ❑ [� ❑ Pump installed in [ n BIOck or ❑ Other__- _Pump Make/Model N 1 .S" Z -1� ' ,Floats or ❑ Transducer 0=.. Tankdrawdown �1I in/min Pump capacity N� gpm Squid Height (9 __ ft Pump on time ImrtM los€Io�E� Pump off time xlif Daily flow set at 740 opd voddmdare11201e Mason County OSS Inst llation Report pg. 2 Parcel a ABANDONMENTRECORD Were existing septic componens abandoned as part of this project? -- ------------ - ❑ YES N Or ❑ NO If yes, please describe all components pumped 0Tt and properly abandoned per WAC246-272A-03UU? ----- -- - ❑ YES N A ❑ NO RECORD DRAWING' Title la a con.c.on..cord and..at be accurate and damrlpll .enough W ea-locate In the need of maintenance activltiaa and future development Typical Record erawlnAs comer erWaNd&manlleld ad. tallan&rayou[SepMrlpump lank sooner,NnM nrmw.maarve dralnmald,saiegn9 and craNsctl bulldinpa,location of wells.Muedlnw, vrelLc,observatlon lwRa,claenoub,sntl olbo malntonanco aaoae patois. nwmplele Rewrtl erawinga maycraele ntldltlonal doloys In Onel lnstsllatlon ayptwal antl related polmlU. ❑ Record Drawing Attached I 'CRIRTIFI0ATIQR'01�;IN$TALLAMON " INSTALLER DESIGNERI 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 tat any deviations shown Mason County Public Health and that any deviations here have been cleared/apltProved 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 l further certify that at/info ation contained on this I further certify that all information contained on this form ad ttached R rtord r 'ng/Is accurate. form and attached Record Drawing is accurate. _ 7- 3-f/ 2Z Igo tore o Instal r I Date Printed Name of Signed MASON COUNTY PUBLIC HEALTH The undersigned approve this Installation Report and Record Drawing on behalf of Mason County Public y �` Health: Signature Ervironne'dai Specialist it Date (stamp, signature and date) THIS FORM MAY BE SCANNEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON OOUNTYWEB SITE Updaled8of.ce KOKANEE COVE z F v � o y \ m m � \ a � o \ \ n z � n R - - - 21 Q 9 v � m � � n > z � L z A w o m 'u F nO z v O � 3 o - ` ➢ � z c � J m m n a i n