HomeMy WebLinkAboutSWG2023-00408 - SWG As-Built - 8/14/2024 r
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICAN l/ Pr M@ v i r ORMATION
Permit Number swD 2023-00408 Parcel# 32023-32-00140
Applicant Name THOMAS WALSH Subdivision(Name/Dfv/Blak/Lot)
Applicant Address 5001 SUNRISE VISTA
City, State, Zip SPATTLE,WA. 98115 Installer Name TRIPLE A
Site Address 372 SE MELL RD Designer Name CINDY WARE
INSTALLATION CHECKLIST
® Fuu System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other AFC 1�
System Type OSCAR Pretreatment Type— 7CO2 F
>5 ft.from foundation? ------ -------- -- -- ----- -- [I NIA ®vas ❑
>50R from walla? ---- -- ---- - - fir. .. U.a`II
El
❑ ■ ❑
=Y >SO ft.from surface water? -- - - -- ___ LSS IL�UJJ u
Cleanoutbetweenbuildingandtank? --- Adn—2-24 ❑ ❑rJ Tank baffles present? ---- -- - - - -- ❑ ■ ❑24"axess risers over each compartment7- 15Y -- - ❑ ® ❑
Effluent filter installed?----------- - ❑ ❑ ❑
Septic tank capacity (working)_ L1<4 j _yal Manufacturer__ tr raeN �f.e Gu- }
0 D-box water level and speed levelers used? - ---------- --- - ® NIA ❑YES ❑ No
LL Manifold/D-box accessible from surface?- ---------- - - --- ❑ ❑ ❑ I.
Check valves installed? - - - —--__ _ ____ ___ ❑ ❑ ❑ {
Transport Line Size 1"SUPPLY AND RETUF Schedule/Class SCHEDULE 40
Bedrooms installed(check one) ❑2 ❑4 ❑5 ❑e ❑Commercial/Other
>10 ft.from foundation?--- --------L-- ------ ❑ WA [3YES ❑ NO
>100 ft, from walla?-- - -------------- ------ ------ ❑ E9 ❑
>100ft. from surface water? --------- -- ---------- --- ❑ 13 ❑
>10ft. from potable water lines?------------ - -------- ❑ ® ❑
> 5ft.from property lines and easements?--- - - - --------- - ❑ Im ❑
>30 ft. from downgradient curtaintfoundation drams?---- ------ ® ❑ ❑
G Dreinfield level and observation ports present - - - - --- - ----- ❑ ❑ ❑
Proper cover installed over drainfield?------- - ------ -- -- ❑ ® ❑
Pump tank setbacks consistent with septic tank?-- ----------- El IRA AYES ❑ No
Y Pump tank capacity(flcod),, laC30gal Manufacturer_
2 '"""EV[:Sr-p e.v� ;r. (.;.•5-)"
f24"access dser(s)and accessible from surface?----------- -- ❑ � ❑
d Alarm or Control Panel Installed? -- --- ----- - ------- - ❑ ❑
Control Panel equipped with Timer I ETM/Counter-------- --- ❑ ❑ ❑
IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
ILPump Make/Model_. __._ ElFloats or ❑Transducer
y a Tank draw down_. irdmin Pump capacity dpm Squirt Height. .. . __,-ft
_.
Pump on time _ Pump_off time __. Daily flow set at zzo god
�« SrF d+ >raL 0%c'9w Qefarce a+v".ft uamaantaa+e
Malson County OSS Installation Report pg. 2 Parcel# 32023-32-00140
ABANDONMENT RECORD
Vv+re sideline Septic components abandoned as part of this project? - ------ ---- - - - 0 YES NO
If as, please describe:
"'Ire all Components pumped out and pmWy abandoned per WAC246-272A-OMC? -------• YES NO
k RECORD DRAWING j
RecentRecentmb YaeaYNhb a pmenee ne ed aM must be xtueab Mx dcrlpl enough to n loade the xE m e tin nee gPM1 ev d A den a-ion. Tyw l. pmhdad d deddnN akmalon 8leydut Sephdpu p+ nk bodion.noon wean N 'stry a non",
rapn b d uFg b- d wane wnMee
W eEeWtlbnpxatlee ,mdothx Innance 2spdt . Icomplim Re coin urennog.tMy mote Wdifionedi,eyn,in Mal installation aeonhulend nYNd pellnNe l
0./ lJLt+.�`is�o, ptfil�sel 4$ F � q/�ROWeaQ eY2f�jrn
"�62 J,),j 'PVn?�a ?oh �fxi�fda
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❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIONEW ENGINEER
I sefll(y that I installed the system in accordance with - I certify that the system has been installed in scoot-
Has septic design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED"by a
County Public Health and that any deviations shown Mason County Public Health and that any deviations P
r, hem have been clearedUapproved by both the designer shown here have been cleared/approved by both p
RG epd Meson County Public Health and meet at/State ' myself and Mason County Public Health and meet It ({p
j and Mason County Codes. State and Mason County Codes
P@ I Ether certify that all information contained on this 1 further certUy that all information contained on this
k fo�Im an attached Record Drawing is accurate form and attached Record Drawing is--curet-.
• t o2'i
arUreo/Insfeaer Date
Piloted No"ofSigneey'�
MASON COUNTY PUBLIC HEALTH �
The undersigned approves this Installation Report and ,A%s N
LICENSE0 OEssaip
Record Drawing on behalf of Mason County Public 11
hkckmRrs ua+w
alth' nJ
Y ,
3 of Environmental Health Specialist Date (stamp;signature and date) ;
b.. THIS FORM MAYBE SCANNEDANOAVAILABLE FOR PUBLIC VIEVION THE MASON COUNTVLNEB SITE uadx.a dmnae
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;. APPROVED ..
AUG 4 2024
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Walsh XO-2 Pressure Readings
III Gauge Readings Gaugel Gauge2 Gauge3 GPM
Discharge pump dosing 45 PSI 45 PSI 42PSI 2.1 GPM
ICI Discfilter flush 11 PSI 1 PSI OPSI
Coilflush 39PSI 35PSI OPSI
APPROVED
MASON COUNTY ENWRONMENiAU hEALTh 1�
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