HomeMy WebLinkAboutSWG2023-00015 - SWG As-Built - 7/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG ZU23-000IS Parcel# 4/1 q2 377 SooOl(7
Applicant Name t4t„t fir+ l (J47UE Subdivision (Name/Div/Block/Lot)
Applicant Address 2123 W WK-L" W*wN P R-D
City, State,Zip C"ELTbW kzjA , g !9 Installer Name 7E-1S IQ FtoL T-
SiteAddress Designer Name &DK1Nti NU NTE.YL
INSTALLATION CHECKLIST
❑ Full System Installation ank(s)Only ❑ Drainfield Only ❑Repair ❑ Other
System Type L7 t'LIq-UI TL1 Pretreatment Type
>5 ft.from foundation? ---------------------------- [I NIA LY'w ❑ No
>50R from wells? ------------- -------- - ❑ 8� ❑
Z >50ft.from surface water? ------------------------- ❑ ❑
HCleanout between building and tank? -------------------- ❑
V Tank baffles present? ---------------------------- ❑ EK ❑
D. 24'access risers over each compartment?---------------- El2/ ❑
WN Effluent filter installed?-- -----------------------—- ❑
Septic tank capacity(working) 1I.h70 gal Manufacturer SOUND 4r W( r=yylh�.Tf
o D-box water level and speed levelers used? --- --- - El NA ❑YES ❑ No
00 Manlfold/D-box accessible from surface?---------------- - ❑ ❑ ❑
t0ik
= Check valves installed? - -------------------------- ❑ ❑ ❑
Cc
rs Transport Line Sim Schedule/Class
Bedrooms installed (check one) []2 ❑3 ❑4 ❑5 ❑6 ❑CommerciaUOther
>10ft.from foundation?--------------------------- ❑ WA EYES NO
>100 ft.from wells?------------------------------ ❑ ❑ ❑
W >100 ft.from surface water? - ----------------------- ❑ ❑
QZ >10f.from potable water lines?---------------------- ❑ El El
K >5ft.from property lines and easements?---------------.- ❑ ❑ ❑
>30 ft.from downgmdiant curtain/Foundation drains?--------- -
❑ ❑ ❑
Dralnfleld level and observation ports present - --- --.- ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over dminfield?------------------.- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?------------- ❑ WA ❑ YES ❑ No
ZPump tank capacity(flood) cal Manufacturer
F24"access riser(s)and accessible from surface?------------ - ❑ ❑ ❑
a AlaonorControlPanelInstalled? ----- --------------- - ❑ ❑ ❑
Control Panel equipped with Timer/ETA/Counter-----------
❑ ❑ ❑
S Pump Installed in ❑ Bucket or ❑ On Block or ❑ Othar
g Pump MakeMlodel ❑ Floats or ❑Transducer
d Tank draw down Wmin Pump capacity npm Squirt Height ft
Pump on time Pump off time Daily flow set at apd
vomroaemaae
Mason County OSS Installation Report pg. 2 Parcel It
ABANDONMENTRECORD
Were existing septic components abandoned as part of this project? - -- ----------- - [D as ❑ No
If yes, please describe'
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - --—- - 2-1-ES ❑ NO
RECORD DRAWING
Thls Is a Permanent—n!and murt be acnaaete and ch—Howe enough to rtJemh In the need a meMenanca.Nettles and future davebGmeni- Typk ll R—W
Do"s wntaln'. Dminbew a marndd wlenlatlan 4 hno SeogVwnng tank m®bon.North alrou.onewe dremneld,eticXtp aM prouosed bulldigs,laat n el wags waterlines,
welts.otuervadon ports,deanoah.end ouwr rreimmanN accss polMs. lnmmplele RsmN Navin,may aeaha atld6onal delaye m final lnetegation approval and nealed penrats.
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I certify that I installed the system in accordance with I 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 ,at 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 I further certify that all information contained on this
form and attached Record Drawing 11 aaccurate, form and attached Record Drawing is accurate.
oneof/nat r V Date
?FS.S 4 F-/OLT
Printed Name of Slgnee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
g �'� '
Signature ofEmamnmental l4said,Specialist Date
(stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAUABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE undawdbHagta
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APPROVED
JUL 11 2024
MASON COUNTY ENVIRONMENTAL HEALT
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