HomeMy WebLinkAboutSWG2024-00330 - SWG As-Built - 8/8/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG La ZN^ a330 Parcel #32a:rr•Sa - 00e1L
Applicant Name Trl IrxV Subdivision (Name/Div/Block/Lot)
Applicant Address q7F a &4'.l Or
City, State, Zip jW-tfsr Wa ffro-' Installer Namb-,?'� '&'n. `�.�.✓r
Site Address Yana Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation C9 Tarl Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type 1544l Pretreatment Type r�
>51t, from foundation? - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ N/A pI YES NO
>50ft. from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - El❑ ,�f
Y >50ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - - Elby ❑
Z
FCleanout between building and tank? — - - - - - - - - - - - - - - - - ❑ C] ❑
V Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑
1 24" access risers over each compartment? - - - - - - - - - - - - - - - ❑ $f ❑
W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - ❑ 15 ❑
N
Septic tank capacity (working) l250 gal Manufacturer Ir1-&JfIK3oe 1" 1750
O D-box water level and speed levelers used? - - - - - - - - - - - - - - - XNiA ❑ YES ❑ NO
DO Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - ❑ ❑ ❑
9Z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑
f]X Transport Line Size 4, Schedule/Class 30y
Bedrooms installed (check one) 02 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - -- ❑ NIA ❑ YES ❑ NO
>100 ft from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑
J 1100 ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - ❑ 1-1 Elu
IL 110ff. from potable water lines?- - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑
Q > 5 ft. from property lines and easements?- - - - - - - - - - - - - - - El ❑ ElW > 30 ft from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ❑ ❑
Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield? - - - - - - - - - - - - - - - - — ❑ ❑ ❑
Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - - NIA ❑ YES ❑ No
Y Pump tank capacity (Flood) gal Manufacturer
Q24' access riser(s)and accessible from surface?- - - - - - - - - - - -- ❑ ❑ El
~ Alarm or Control Panel Installed - ❑ ❑ ❑
o ?
Control Panel equipped with Timer I ETM /Counter - - - - - - - - - ❑ ❑ ❑
a_ Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
fY Pump Make/Model ❑ Floats or ❑ Transducer
f
a
Tank draw down in/min Pump capacity gum Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
uooa.ea mname
Mason County OSS Installation Report pg. 2 Parcel# 3a/97-56- ecn"N
ABANDONMENT RECORD �/
Were existing septic components abandoned as part of this project? - -- - - - - ---- - - - III
I YES NO
It yes. please describe T
Were all components pumped out and properly abandoned per WAC246 272A-03009 - - - - - - � YES E] NO
RECORD DRAWING
rme a oe,manem atom a„no mn.t tee mmerme and deacepeve mmagn to relocate in me need or maintenance aawdma and rate,.d-na.,mem. ' o-I nar:om
o,mvl11omn - Infl,1uI"n'n , ad n ,,an x lavou. so,tpe ne tan, n n - nun dnv _L rei Ic and n w— o JdiI, —at,. .II, wmedmea
eie. ry ii, crri, 1,, 5 and oho.ma eec oar,ngsw c .)P 'll, c � delnY` I I hll.no^npp'c'r.+ a.d rnlaed pennils.
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 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 clearedlapproved 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
I further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate form and attached Record Drawing is accurate.
Q�z 8/a'/�i
Signature of Installer Dale
—
J -)i;( 30 ,-(
Primed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health,,'
(�
` ,11- X `'n �Iwlz4
Signafur of Environmen I Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE r.."r`emi xee
I .
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I
APPROVED
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BAMFORD SEPTIC REPAIR, LLC
- 301 E WALLACE K EELAND BLVD
STE 332
SHELTON,WA 98584-2985
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