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Home My WebLink AboutSWG2022-00138 - SWG As-Built - 8/7/2024 Mason County OSS Installation Report pg. 7 MASON COUNTY P 4 qUG Lpls APPLICANT/PERMIT INFORMATION Permit Number SWG 7-d 2 Z— (30 l Parcel# L IZ O -,�p _'7,i qa o p�- Applicant Name 0 U O-jU Subdivision (Name/Div/Block/Lop Applicant Address I L( � O 'll (,-T- C �x,rC%+ `.$a✓S i Ivti� City, State,Zip �:e�c�-i�' tic�_9£iV1,>installer Name Site Address ib Y -- Designer Name INSTALLATION CHECKLIST IP Full System Installation ❑Tankts)Only ❑D1alnfleld Only ❑Repair ❑fOtther System Type Ntil Pretreatment Type d7/V�Q� >5 ft. from foundation? •-------- ------------------ [I NIA YES NO >50ft.from wells? ---- -- - -------- - - ------- - - -- - ❑ ❑ Y >50ft,from surface water? ---- - --- - -- -- -- ---- - -- -- ❑ ❑ ❑ Z H Cleanout between building and tank? ------- ------------ ❑ ❑ ❑ tl Tank baffles present? --- - -- - --- -- ---- --- --- - --- - ❑ ❑ a24"access risers over each compartment?--- - - -- - - ------- ❑ ❑ NEffluent filter installed?- - ------- - ---- --- 0- ❑ ❑ Septic tank rapacity (working) I j. gal Manufacturer F 9 D-box water level and speed levelers used? --- --- --------- )/] NIA ❑vas NO p0 Manlfold/D-box accessible from surface?-- --- ----- - ---- --U. ®' ❑ ❑ MF Check valves installed? - ------- ---- - ----- - - ----- - ❑ -i� ❑ G Transport Line Size r11 Schedule/Class ZAA Bedrooms Installed (check one) ❑ 2 X3 ❑4 ❑ 5 ❑6 ❑Commer dal/Other >10ft.from foundation? -- -- -- --- - - - - - ---- --- - ---- ❑ NIA ®YES El No 9 >too ft.from wells?- ---- ----------------- - ------ El j�] W >100 ft.from surface water?----------- - -- - ---- ---- - ❑ B ❑ LL >10ft.from potable water lines?--------- - ---------- - - ❑ I� ❑ Z > 51t.from property lines and easements?- --- - ---- ----- d — El 9 130 ft.from downgradientcurtalNfoundabon drains?- --- -- ---- ❑ ❑ G Drainfleld level and observation ports present - ---- --{3Frv-r'1- -- ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over dralnfleld?---- ----- ---------- ❑ ] ❑ Pump tank setbacks consistent with septic tank? ------------ ❑ N/A ❑ vas ❑ No ZPump tank capacity(Flood) I 1 gal Manufacturer b4 "1 c-e Q 24"access risers)and accessible from surface7------------- ❑ 0 ❑ dAlarm or Control Panel Installed? --------- ------------ ❑ [a ❑ Control Panel equipped with TlmerI ETM/Counter-- ---- - ---- ❑ �]r ❑ rl Pump Installed in ❑ Bucket or ❑ On Block or ❑ Other fPump MakelModel S'mot, Floats or ❑Transducer D Tank draw down L I/ a L in/min Pump capacity 70 gpm Squirt Height ft Pump on time a.e Oj Pump off time 'L,1W Daily flow set at 30 opd UNOMd W1h010 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENTRECORD Were existing septic cemponents abandoned as part of this project? ----- -- ----- --- ❑ YES ❑ NO If yes, please describe: Were all components pumped out and property abandoned per WAC248-272A-0300? -- --- -- - ❑ YES ❑ No RECORD DRAWING Tole 6 a permanent nwnd and meet be acamaY and daaalpNue amend b nAactle In me bond M mtlntena ml aelMesa and future arvalvpmont Tindal Room 0.npe wnuh Promos amed'I pdardi.n&leynW,eplwpump and kEatkn.NaP snow,ra—dnMMN.WaIng and pmPoeea aullainga,mention N Weee,wmeAlnea. LLYG,p�awadw pMe,tlenuW,aM ONe(nulnlawip eases poNle. Mmnpkla Rew'd dewMge lney Male eddbbnY deYyeNMtlnleYelYM eppmnl end fabled pemlln. ❑ 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 meet all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes 1 further certify that ail inforelaflon contained on this I further certify that all Information Contained on this form and a h Record Drawing Is accurate, term and attached Record Drawing Is accurate. Slgrathis of Installer Defe 1 j , Az/e: r,\/K Printed Noma of Signed MASON COUNTY PUBLIC HEALTH N The undersigned approves this Installation Report and 51U0112 'IO Record Drew(ng on behalf of Mason County Public o`,'' Aa4rI J.nUNTeR Health: 11Ci'N:;10 5�dAyl ` Signature ofEnvironmental H ellh Speclallsl Date (stamp, signature and dale) THIS FORM MAY BE SCANNED ANO AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upaalaa exladm 0. r � 3 i LS ETEST CEMILIToev xs— TIMERSE ax naNG Ste. IIM HUNTER&ASSOC. APPROVED ,on� AUG 0 7 2024 ?ET