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HomeMy WebLinkAboutSWG2024-00237 - SWG - 8/5/2024 M&Bon County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number Swo Zo Z Y- oral 3-7 Parcel ll 320 3c . y/ , 000 , Applicant Name alnru_i QTr1a� Subdivision (Name/Div/Block/Lot) t ApplicantAddreea �570 City, Stale, zip ha lim r �a Qj) a Installer Name �r +ir) >rPl x FO 81to Address Designer Name Lqe INSTALLATION CHECKLIST Full system Inalallalm ®7nnkt�y only ❑ nrainfli Only ❑Riepmr ❑Od,rr Billiard Type yn�=it-A.2 X U L Pretreatment Typa_13:i�AAl - `-�- Pit III from foundation? -- -- - - - - - - . _ - - - I- - - - - - - - - - -- [] WA �+res ❑ No s50%, from walk? - - - - - - - - - - - - --- ❑ ❑ 2 40%, hem aurfaoe water? - - — - - - - - - - — ❑ ❑ F Cleanoul between building and lank? • - _ � LS ❑ C? Tank ftaf its present? _ _ _ _ _ _ ❑ ❑ a 24"aonoss risers over each compartment? JUL- 31_A24 _ E%luenl filter installed?- - - - — _ . . ` - - - - - - ❑ ❑ Wild tank capacity(working)_-. (04 ey ` -Sp s' D-box water level and speed leveler;used? - - - - _ - - - - - - - - _ . Ip WA ❑ YES ❑ NO ManlfoldlO-box accessible from surface?- - - - - - - - - - - -- - -- - ME Check valves Installed., - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . 6< d ❑ r 2 Transport Line Size 1 Schedule/Class_yd_ _ Bedrooms insialled (check one) If2 ❑3 L]A [] S r]S `❑Commerclavolher ­ »10%. tramfoundation?- - .. .. _ _ .. _ _ __. _ _ > _ _ - ❑ NIA erYE; ❑ NO � A9110%, from wells?- - - - - a. = .. . . ... . . . . . . . . ... . ., ❑ JN ❑ lj a100 ft. frogt surface water? . . . . .. . . . . . . . . . . ❑ ❑ tL +10 ft. from potable water linas?. . . . . _ . . . . . . _ _ _ _ _ _ _ _ _ , ❑ afees � ❑ Z s®%,from property s and easements?- - _ _ _ _ _ _ _ _ _ _ _ _ _. ❑ pt in > IleEl 30 ft, from downgradianl auftnin/foundation drains?• _ - - - . _ . _ , K❑V ❑ Drainfield level and observation ports present - - - - - - _ _ _ __ _ _ . ❑ ❑ L] Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed Over droinfield?- - - - - - - - - - - - - - - - - -- ❑ ❑ Pump fork setbacks consistent with segos lank?_ _ _ _ _ _ _ __ _ _ _ _ ❑ NIA M Yes ❑ No Z Pump tank capacity (flood)_- 12-3lga1 Manutacturar,_.`Jh'SEl •�Y H 24 access riser(;)and accessible from surface?, - . - - _ _ ❑ y Alarm or Control Panel Installed? - - - - - - - - - - - jPUMP ❑ ❑ Control panel equipped with Timor/ETM/Counter- - - - - _ ❑ ❑ \` r1 installed In ` ❑ Sucker or D5 On Block or ❑ Other Pump MakafModal Mt (o1"JD yx LT—LP ❑ Floats or v— y�M- A ❑ Transducer Tank draw down I, 25 _Inlmin Pump capacity • �S_gpin Squirt Height _` u Pump on time ©�c 1a'� �jYp� Purr off lime Q.LA p Deny now sal at 2 7C r_yI,d Mason County OSS Installation Report pg. 2 Parcel a _'31 e 3> -If•• l cx• JL_ ABANDONMENT RECORD Were existinq s'phc compor"ols ghNlltlell¢d as Part of [Ilia Propel? X, YES NO 11 yes, please de"ohe Were ell culnpulleltls pumped o ll and PIaPeNy abandonod par WAC240•212A-0$00'- - Yes NO RECORD DRAWING *Xq 1a n pA s...ill hnPM"nd m991 49"ecupll9 end dimlnpnK elmuyu lu rv.IJnu IP mP nerd M m911nmeK9-.Ndln"9nn roan.n•wlupm.P1. ql'x m 1,d lennmrn moil(,, {Illµrµ1414 rPpldyJ NiMl911q`A I9Prv1 WL'4111N1111`.nA I•rvp14m N.nr119r nw 19xMP NMrr NN ..play non 1`n mwll VwxOny'• M¢a4M M wnllx.W419rWW. wfllF ubSnrvAllnn 1161a.NPMMIIA.pM BIM111'n19141NMTV xIg91YWV. AP+9n11PV Nenyrl lugnmllLUPY'.qrb n.4L4rxrnl Jdq.-�n llnAl m"mA:Ouxr ePl'yN91 aN rNNIM1 YMI1111A. KRecold Urawiag Atlaohod CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that f installed the system in accordance with I certify that file system fins been installed in accor- the septic design slamped"APPROVED•'by Meson dance with the septic.design stamped"APPROVED"by County Public Health and that any deviations shown Mason County Public Health end that any deviations here have beer,cicardidlepproved by both the designer shown hem have been cloamdleparri by both and Meson County Public Heath)end,live[all Slat¢ myself and Mason County Public Health and hill all and Mason County Codes. state and Mason Calmly Codes 1 nInher Crolify(fiat ell imfarolalHD1 Cedained all this I further Certify file(lilt inforlilefical contained oil this form and attached Primal Drawing is accurate four and attached Record Drawing is accundr, Q- /, A- '7)31 I- l Sfgnaturt+ollrr.v[a7le'i` Date ? . Ponied Name a/Stgnee `^ MASON COUNTY PUBLIC HEALTH A > s �\ h Q CI E alir: The undersigned approves I 4hdlafldlry d`n `Q L 9Ee IGNER Record Drawing on btlbal/uf Ma Ma rt shy^I",!,{,, ," 101y Ex9191s uxla ^" Health: } ry"phy/RO Y�,� 8/f/C c/ °jq t Signahrm of Fnvimnmenfal Health Specialist Dole (Stamp, Slg/latllm and data) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 1"el"Ialxn.enm q U'1111 M c� V i `1 t LICE EDONIGN[R' r i i cruiME9 nsgN m I . I y pAVG Po aeoN�o�ro s 2ppy M 1� DJ 0iV'Mfar44 K --t co `. y4K1 ro ^. V - C N D 0 0 C .Z7 \y � " � a S aaC, ro x , •; ; ro � � ro 0c roger ro 5- 3 Er= _ ro o � • � I ry' ( BASAL WIDTH � z cli ? jI� a ,.r. 6 N w ry�v 9 1 w a �ApRp LICEHS oEo�a It AS�N�OpNry N�a S�?y o ��� O�q�MF,yTq�