HomeMy WebLinkAboutSWG2024-00342 - SWG As-Built - 9/10/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG7W.4 - (,g) Parcel# -;Z61(6' 56 - 03C1 )
Applicant Name Q)p,lynta Subdivision (Name/Div/Block/Lot)
Applicant Address 1351 )oY%S S+•
City, State, Zip 51no\1lzY11WP% Q(?siSVj Installer Name
Site Address 1351 .%hLS $±• Designer Name
1 INSTALLATION CHECKLIST qN�O
ElFull System Installation Q Tank(s)Only ❑ DrainFleld Only ElRepair ❑Other SystemType Y Pretreatment Type>5 ft.from foundation? - - - - - - - - - - - - - ----- - --- ----- ❑ NIA QJ YEs>50ft.from wells? -------------- - - - - - - - - - - - - - -.- 0 ❑
Z�19 >50 ft.from surface water? -- - - - - - - -- - - - - - - -- -- -- - - 1 ❑ ❑
FCleanout between building and tank? -- -- - - - - - - - - - - - ---- ❑ er, ❑
f.7 Tank baffles present? - - - - - - -- -- - -- -- -- -- -- -- -- - - ❑ 0 ❑
6~. 24'access risers over each compartment?--- -- - -- --- -- - - - ElET 1-1
W Effluent filter installed?- - -- ---- -- ---------- ------ - ❑ r 0, ❑
0Sepfic tank capacity (working) Z5 0 aal Manufacturer Irl n � �YGt'c )y
C D-box water level and speed levelers used? -------- --- - - - - ❑ NIA , "YES ❑ No
OJ
LL Manifold/D-box accessible from surface?- - - - - -- --- - ----- - El Er El
a?= Check valves installed? - - -- - - - - - - - - -- - - - - - - - - - --- tgJJ ❑ ❑
f Transport Line Size 1IlC.h Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?-- - - - - -- - - - - - -- - - -- -- -- - -- ❑ NIA ❑ YES El No
G >100 ft.from wells?-- - - - - - - - - - - - - ------------- - - ❑ ❑ ❑
W >100 ft.from surface water? - -------- -- - - - - - - - - - --- - El ❑ El
LL >10ft.from potable water lines?--------- - - - - - - - - - - - - - ❑ ❑ ❑
Z > 5 ft.from property lines and easements?- -- -- - ❑ ❑ ❑
> 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
`1 Pump tank capacity(flood) pal Manufacturer
Q24"access riser(s)and accessible from surface?- - -- - - - ------ ❑ ❑ Cl
N
A. Alarm or Control Panel Installed? ----- -- - - - - - - - -- - - - - - ❑ ❑ ❑
2 Control Panel equipped with TimerIETM/Counter-- -- -- -- -- -
❑ ❑ ❑
fl Pump installed in ❑ Bucket or ❑ On Block or [I Other
fPump Make/Model ❑ Floats or ❑Transducer
Tank draw down in/min Pump capacity pm Squirt Height ft
IL
Pump on time Pump off time Daily flow set at apd
Million County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD �/
Were trusting septic components abandoned as part of this project? Ip----- - - - - - - - - -- YES NO
If yes, please describe: abixndou,3I m XUL
Were all components pumped out and property abandoned per WAC246-272A-03007 - - - - - - -- Iff YES ❑ NO
RECORD DRAWING
TMa is a pnmmem ncnN and court W attluale and dascdpllw enough to n *N In Me road er malmunsmu acUveles and Mum d.nmiu mant. Tyycai Racda
Dawinps cdNein' crainleldB manHdd ommadm&laymy,Sep6r/Wmm lank location.Norm arms,reams dmima[d.nlsGng and pap mu buildings,bwtion Nwdls,-dadinea,
wells,ahervadon Oorls,tleanw6,antl dher maiNanence a¢ess pan6. IncmnPWe RecoN Dravmps may cmale addtlbml delays m frel inslelladar apprmal and matad pemns.
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 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
hem 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 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.
//
Signature of Installer Date
-z)hahe muy An_
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH,g,, p O
The undersigned approves this Installdflftp,� rtFf d 0 1
Record Drawing on behalf of Mason Countyd7pN ylR 4
Health:/���/ 0J �j ?OJT 0
H/ /�' y1M1/ OL l A(yFAUy
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Ua laird Wlrzwg
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APPROVED
SEP 10 2024 APPROVED
MASON COUNTY ENVIRONMENTAL HEAM DJA AUG 14 2024
MASON COUNTY ENVIRONMENTAL HEALTH
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