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HomeMy WebLinkAboutSWG2022-00578 - SWG As-Built - 7/24/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SING GU Z 4 - a=5 71f Paroel it u ZZ16-- )i.- tg Applicant Name Subdivision(Name/DIv/BIOCk(LOt) Applicant Address �> h,,.-,,- .e I Loy )b City, State, Zip u�Io� Installer Name T) Lo,xrs Site Address 1J l"/4%^ L. Designer Name ,l�<�••.. H"ctko rr.d� INSTALLATION CHECKLIST [3Full System Installation ❑Tank(s)Only ❑ Drainfeld O El Repair [I Omer System Type C -cr U Pretreatment Type A..b. . >5 ft.from foundation? ------ - - JE-IM RMR -- ❑a/.0 ❑yes ❑ xe >50 ft.from wells? -_ ________ _ __ _ _ _ _ _ _ _ __ _ _ ❑ 0 ❑ z >50ft.fromsurfacewateO --- - -- - - UE- - 2&24- -- ❑ p ❑ HCleanout between building and tank? - - - -- - - - - - -- ❑ ❑ ❑ U Tank battles present? . - -- - - _ _ _ B - _ _ _ _ _ _ - -. ❑ 13 ❑ 1 24"access risers over each compart -- - - - ❑ ® ❑ W Effluent filter installed?- -- ----- - - - -- - - - - - - - - - - --- - ❑ [a ❑ to Septic tank capacity(working) - qa Manufacturer �_,yr� �tik�,v� PIC- (Cl y `0 D-box water level and speed levelers used? -- --- --------- - El NA ❑res ❑ No 000 Manifold/D-box accessible from surface? - - --- ---------- -u. ❑ 0 ❑ 992 Check valves installed? - - - -- - - - - - - - --- - - - - -- - --- ❑ © ❑ oa 2 Transport Line Size Schedule/Class ' Bedrooms installed (check one) [32 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- --- - - ---- - - - -- - ---------- ❑WA ❑yes ❑ No >100 ft.from wells? -- ------ ❑ Q ❑ W >100 ft.from surface water? ----- ----------------- - ❑ 0 ❑ u. >10 ft.from potable water lines?- - ------- ------------ - ❑ ® ❑ QZ >5ft.from property lines and easements?--- -- ----------- ❑ C3 ❑ 1' >30 ft.from downgradlent curtain/foundation drains?- -------- - 0 ❑ ❑ Dramfield level and observation ---- --ports Present - -- --- -- 0 0 ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) C - -I Proper Cover installed over drainfield?------- - - - -- - --- --- ❑ [] ❑ Pump tank setbacks consistent with septic tank?------ - - ---- - ❑ WA Q We ❑ NO ZPump tank capacity(flood) oal Manufacturer F(g��VtMur\ l ri. [o9Y F 24"access riser(s)and accessible from surface?-- - - - -- ------ Ala"or control Panel Installed? ------ - --- -- -- ---- -- - ❑ ©. ❑ jControl Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ a ❑ n. Pump installed In ❑ Bucket or ❑ On Block or ❑ Other Pump Make/Model ® Floats or ❑ Transducer a Tank draw down in/min Pump capacity qpm Squirt Height ft Pump on time Pump oft time Daily flow set at opd uw.+a rrzaore Mason County OSS Installation Report pg. 2 Parcel# 42Z16 -ST-Oc1014 ABANDONMENT RECORD Were misting optic components abandoned as part of this project? ---- - -- --- - - - -- ❑ YES 'I/A No If yes. plea.describe'. N f� Were all components pumped out and property abandoned per WAC246-272A-03001 - - - - - --- ❑ YES M'No RECORD DRAWING rMa M a pemwMm mo,a am mist M xcu,m am avwyun P^o�98 b.P+anP In mP mee a nvlmx+ana anlww anti rimn.a�,PraOrrrdrw rtyiw Bd6vtl prvu.+ys cglYn Ll9'mfitgA!uniloM GronbLm dlald:1.SeIX+/Gump'ankMGWn.NOM Y+Ow.,PSPnP frzmRek.emAn9 ark Wgmetl Euikryc,buEen>W.wdxFPf. vMh,oMervPivr WrU.MaMu6.i!k OPx misxnmrss mY pFR. 6gn4e!e ReWO Dr3`ngt rode ueele aW Wncl EPIey it IiNlBnleblm ap6aN tilt rPIeW ppniitl. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with I certify that the system has been instalfed 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 I further certify that all information contained on this 1 further certify that all information contained on this form and attached tort!Orawmg is accural form and attached Record Drawing is accurate. Si,natuns d Instiller Dare �A�Y H(/ AN ., cy Pnnted Name of Signed �• Ni FN S MASON COUNTY PUBLIC HEALTH \9� aS22� ca w The undersigned approves this Installetton Report and �"s\r TEP,• " Record Drawing on behalf of Mason County Public Health: Signature of Environmental Heatth Specialist Dale (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uw.we m"�ie woa' nNUM®uWM Z15tl NWHO 3 Y +y $g € MS.V 1000�E5�9 Iu�W Wtl 9S098SL(fSZ) NMVOl S401 ONIHMN1°JN3 �tlM'Nu.0 uosery p S3HJf1H Wtl3 6ulmema p�oaaa opdeg :aw xw •eoww Q � < b � F 7 w a � � Q. I i Y � 3� r s R G � vV� im 3 z 5 � _ � UC� I all �o ' Ir mlm� z :'aa, V tgg +� E 8 /.V z W Z 3 WN C fi�yNZ yW N X m w�q¢O �Zu q a x a wa' Y. WNN E A EI J m b zwo i C FonE �� � Wtz a— 80 ¢ Z yK�W $$ 8 O 3p Nq�ZWF ZF.2 O p < S [S iimw� i Dais N e 5 5 s 5 m W g w <�° F o r3 0 9 g 6 r7i m A R' WOU' 3 HZ11 a a y �uia 30om