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Home My WebLink AboutSWG2024-00001 - SWG As-Built - 6/7/2024 Mason County OSS Installatio=BOX Report pg. 1 APPLICANT/PERMIMASON COUNTY PUBLIC HEALTH er SWG 2024-0001Parcel* 42329-50.00171 me RALPHINANCY SCHAFFER Subdivision(Nams0v/Block/Lo0reas po BOX 174p HOODSPORT WA 9B54B. Installer Name TRIPLE A �/� �rl7esigner Name CINDY WAITE ��J� INSTALLATION CHECKLIST ❑Full System Insionaum ❑Tank(a)Only ®DreioflNd Only ❑Raper ❑Oabr System Type GRAVITY Pretrmlmenl type >5 R from foundatlon? �— ❑WA >SOR from walfal -------______________ 0ras ❑� -50Rfrom surface watar7 ------------'---'-- ❑ ❑ ❑ F- Clmnoul between building and tank? ________________-_- ® ❑ Tank baMm present7 __________________. ❑ ® ❑ 24'access risers over seen Ocmpartment?---'___-__"""' ❑ ❑ Ir11 Effluent filter installed?._-QL-_lZZ---------------- ® ❑ O Septic tank size 1000 sal Manufacturer ■ ❑ EXISTING q. D-box water level and speed levelers used? _____________ tri=r` ManIMND-box accassible from surface?-_______________. ❑WA ®Yes ❑ e0 Check valves Installed? ----________________ _ ❑ ® ❑ i aa i. Transport Line Size 2"T04' SChedule/C19es SCH❑l T03034 ❑ ❑ Bedrooms Installed(check on Q 2 ❑3 ❑4 ❑5 ❑8 >10 R from foundation?----_ ❑CpmmeroiaU0lher p >100 R from wells?------------- . ® .VA ®Yes ❑ NO >100 a.from surface water?.______________________. ❑ ❑ ❑ >10Rfrom Pobble..is, ---------- ® ❑ >5Rfrom property lines and comments?---------------- 0 ❑ >90 R from down0redlenl curtaintioundatlon drains?-________- ® ❑ Dminfeld level and observefon ports present______________ ❑ ❑ ❑ Grevefass Chambers or ® Clean gravel used? (check one) ❑ ❑ Proper cover Installed over drainfleld?---_______ Pump tank setbacks c�oyn�a/lkstantwith septic tank?--C-__ .... ❑ ® ❑ 2 Pump tank eke+�--t-�� ❑ WA No sl Manufacturer.- iJ M �,�„)G f 24'access dser(s)and aecesslble from surface?-_________--- ❑ 'Ja5 LA A. Alen or Control Penal Installetl7_____________________ ❑ ❑ Control Panel equipped with Timer/ETM I Counter----___ ❑ ❑ XPump installed in ❑ Bucket or YfOn Block or ❑ Other ❑ ❑ ❑ Pump Make/Mode V � '�--�*. 25A ,,,r "-'� pD Floats or ❑Trensduur R Tank drew down Irumin Pumpcapacity opm Squlrt Haight Pumponnms fr Pump att uses Daily flow ml at .�4mp ory xy1 apd K e{se/� vec.asmrmie Mason County OSS Installation Report pg. 2 Parcei# 42329-50-00171 ABANDDNMENTRECORD Were existing aeplic ppmponenls abandoned as part of this pmlect7 If Yes,please describe' . . _____________ ree NO Were all cons"Peols Pumped out Sn l prapBrlV abandoned pal WAC24627A-03007 ---- ---- 0 YES NO RECORD DRAWING i lq b L pMmwnl ucgp LnL muYl pL XLunY YN pLLp11p11yY ulouyp p ml[[N In IM pNtl Of TYInanLM LGXVNX Ynd IuNIL E 1Xlai p[n'.a� pe.l pg6cTXq tlbngYM♦ RnLnt r.- R. MY a'aLa�m IYnL.<Iw/y[[w1 pGvnWnlYnnyp�Yb}•Tp1u.Y YMM,ly yVIW.ILLM dLntaq YWeq Yq 4NW[nE puklgl YstlIT L dwd[.wb'Iry[. NX.M[MpMp RNflpdryyyL R.Yy VLpb La11gIYlaLyyl T rr.,Inpb^nM I ttXnl NpnlslLp pylniL i 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 m accor- the septic design Stamped APPROVED'by MesonCCV tlance with the sephedesgn sfemped'APPROVED'by hem hem boon n1sa°h and that any deviations shown Mason County Public Health and that any dth,mens here hoes 6asn clearedyepprored by Coln the tleslgm�r � shown here h and Meson County public Haellh and mast as Slate eve been ClaalBd'opprOved by both and Mason County Codes, myaeff entl Mason County Ppbl¢Hoene and meet ell I further Canby that all lnfofmation rontelned on this Shi and Mason County Codes I further Carley,that ag information Contained on this form end attached Recur wino is eaurate. /r� form and ettecnetl Record OrBwing rs accurat,. afore o/InaleWr Dale Pentad Mama o/Sgnea MASON COUNTY 7L'BLIC HEALTH 7h0 ontlefogn97 eppfoms this Installation Rapcn and A e1J IpII ReCatd Dawino of beialf Of Mason County Public LICENSED DESIGNER Sltmsasa clEndmnmentq;Neel Spxleasf pale 11"\ (slamp,Signature end data) CanI . .'BE SCANNEOANOAVAIASLE FOR PUBLIC NEW ON TIE IMSON COUNTY\NEB SITE uusr m�mn �.•ne.av—wtl —. ! a tl d cl E 9ffij , n ccF FHA o . xx = q e QL 4wiron06 APPROVED 10 w, JUN 07 2024 MASON COUNTY ENVIRONMENTAL HEALTH _..................................am ...... ADAM12 1 .V lip QL i ri o Simla %\ a \ �EYEIND WARE NOSED DESIGNER h 6wYi/651ry 1 � Ill•r`/ 1_ I� yam__ r c � �0 ¢luew �t 3$` ,� gas•/ — y OF�eLu./'.� APPROVED �R �ME ( �� lMENBFL OGBXiNER a ,H 1UN 07 2024 MASON COUNTY ENVIRONMENTAL HEALTF. RET