HomeMy WebLinkAboutSWG2022-00333 - SWG As-Built - 7/12/2024 Mason County OSS installation Repot pg. : MASON COUNTY PUBLIC HEALTH
APPLICANT/ r'E-d??AAT INFORMATION
Permit Number SANG 2QZ2--Do -1??13 Farces a 72017 X177
Applicant Name LevE _'Ferr-� Subdivision (Name/Div/Block/Lot)
Applicant Address e IICk
City, State, Zip �)C[Jl 7h, via 'U5W Installer Name 4-4
Site Address 8( >• P41M- D'r Designer Name
INSTALLATION Ci 3 E.0 KLIST
❑ Full System Installation ❑Tank(s)Only ❑ 2m.in-ield Cn!y yRepair ❑Other
System Type Pratreatment Type
>5ft.from foundallo0 --- --- --- -- - - - -- - - - - - - - ❑ N/A YES ❑ NO
>50ft. from wells? - - - - - - --- - --------- -- - - - - - - - . ❑ V' ❑
Z >50 ft. from surface water? - - - - - - --- -- - ----- - - - - -- - - ❑ ❑
HCleanout between building and tank? - -- - ---- -- --- - -- --- ❑
O Tank baffies present? -- - - ---- - - .. - -
❑ ❑
1t- 24"access risers over each compartment?- -- - --- - ---- - - — ❑ ❑
WEffluent filter installed?- - - -- - --- -- --- - - —... ... . . .. . . .. El
Septic tank capacity(working) gal Map ulactuler
o D-box water level and speed levelers used? - - - ❑ ❑- - - - - -- - NIA Yes NO Ir
0O Manifold/D-box accessible from surface?--- - -- - - _.- - --- -- - • ❑ ❑ I
Check valves installed? - - - - - - --- --- - - - - - -- - - - -- --
GQ ❑ ❑ dd
z Transport Line Size _ Ct:hedule/CieSS
Bedreoms lnstalieo (checi:one) ❑ 2 ❑3 Q 4 5 ❑6 ❑Commercial/Other
>10 ft. from foundaticn-- - - - - - - - - - -- -- -- -- - -- - - - -- NIA ❑ YES NO
>100 ft. from wails? - -- - --- - - - --- --- - --- - - -- - - ❑ F1
W >100 ft.from surface water? - - - - - - --- --- -- - - - - - - - -. ❑ ❑
M >10ft.from potable water lines?--- -- - - - - - - -- - --- -- - -- ❑ ❑
Q >5ft.from property lines and easements?- - --- -- --- - - -- - -
❑ ❑
Q >30 ft. from downgradient curtain/foundation drains? - - - - - -- - - - ❑ ❑
Drainfield level and observation ports present - - - ------- --- - - ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (chec::one)
Proper cover installed ever drainfield?- -- -- - - - - - - - - -- - . -- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank'? - - -- -- - ❑ NIA ❑ YES ❑ No
ZPump tank capacity(flood)_ ga1 Manufacturer
Q 24"access risers)and accessible from surfac ?-- - - - - - - - ❑ ❑ ❑
IL Alarm or Control Panel Installed? - - - - -- - -- - - - - - - - - El El El
Control Panel equipped with Timer/ETM/Ca:_ _ _ - ❑ ❑ ❑
a Pump installed in ❑ Bucket or n Block or ❑ Other_-
a Pump MakelMotlel ❑ Floats or ❑ Transducer
_. --
Tank draw down in/min Pump aci p- p ca p ty____ypm Squirt Height ft
Pump on time Pump off time _ Daily flow set at gpd
JpEeul flQll]016
Mason County OSS Installation Report pg. Parry is 2�1�• g I' Z�
ABAND0hL1li',ENT RECORD
Were existing septic oomponents abandoned as - - - - --- -- - -- -- ❑ YES [ NO
If yes, please describe:
Were all components pumped out and properly abandon?par WAC246-272A-C300? ❑ YES NO
RECORD DRAWING
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MGW Rue^gyp. QA~J�� Fo c l"fp ;
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❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that installed the system in accordance with = 1 certify!rat the system has been installed in accor-
the septic design stamped"APPROVED"by dAason f deni-L 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 meet all State mysalf and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
1 further certify that all information contained on thin I further certify that all information contained on this
torn and attached Record Drawing is accurate. form ano attached Record Drawing is accurate.
-7 62fzjj_.. y
Signature o staller ,� DWI'
Printed Name of Signee � TJtO
MASON COUNTY PUBLIC 14FALTH
The undersigned approves this installation Report 4oC
Record Drawing on behalf of Mason County Pool,;,
Health: C^^^ -7
Signature of Environmental H atn Sproialist Jere (stamp, Signature and date)
THIS FORM MAYBE SCANNED AND AVAILAELE FOR PUBLIC VIEW ON THe MASOH COUNTY WEB SITE upaaua wnnms