HomeMy WebLinkAboutSWG2024-00270 - SWG As-Built - 9/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
j APPLICANT/ PERMIT INFORMATION
Permit Number SWG Z-U ' OQ7,'7 b Parcel# 2-2:3,G - S 3 - 0010 C'
Applicant Name (py� Subdivision (NamelDivlBlocklLot)
Applicant Address �q n 6,rr U r(.( Sr
City, State,Zip �1.,,Cj il/A !j Anstaller Name
Site Address l NC hnfhn R,� Designer Name )
INSTALLATION CHECKLIST
❑Fu1 System Installation ❑Tank(s)ONy ❑Drainfiew ONy Ltd nepair ❑Other.
System Type Pretreatment Type ,,���///
>5R from foundafio ? -_________________ t�y,,�'l ❑ NIA It/�{Es ❑ NO
>50 ft.from wells? ------------__ IIpp -_`____11-�� ��TJ/ ❑
Y >50ft.fromsudacewateR --------- LS- -o- f111 El
Z LtLWIIIIIJIII
F Clearwut between building and tank? ---- ----- --- ❑ ❑
L_ l--.y-
tJ Tank baffles present? ------------ � ❑ —/ ❑
a 24°access risers over each compaMtanl?• ---f1/,�y�k,Lµyl- ❑ L)Y ,❑,/
W Effluent fitter installed?------------ BY---W------- ❑ ❑ `IJ'
N
Septic tank capacity(working) (ZOcI aal Manufacturer
0 D-box water level and speed levelers used? --------------- ❑WA LIKES ❑ No
pJ
0 ManifoldM-box accessible from surface?----------------- ❑ ❑,/
mZ Check valves installed? -_________________________ ❑ ❑ [y
0f Transport Line Size yr Schedule/Class i 03-L
Bedrooms installed(check one) ❑ 2 3 ❑4 ❑ 5 ❑6 ❑CommerciaVOlher
>10ft.from foundation?-----------------------
[3 WA �Yla ❑ NO
>100 ft.from"Its?----------------------------- ❑
w >I Do ft,from surface water? ------------------------
❑ rr��
a >10ft.from potable water lines?---------------------- ❑ r���// ❑
ZZ > 5ft.from property lines and easements?---------------- ❑ U7 ❑
R' >30ft.from downgradient curtaintfoundation drain?---------- ❑ ,ll.7/ ❑
0 Drainfield level and observation present -------------- ❑ LJ" ❑
❑ Graveless chambers or Clean gravel used? (check WO)
Proper cover installed over drainfield?------------------- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?--- -- -------- ❑ WA ❑ ves ❑ No
Y Pump tank capacity(flood) aal Manufacturer
Z
24•access riser(s)and accessible
e from surface?-------------
4 ❑
9 Alarm or Control Panel Installed? ------- -- --- ----- ---- ❑ ❑ ❑ .,
IL
f Control Panel equipped with Timer I ETM ICounter- - --- --- --- ❑ ❑ ❑
7
o• Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
o• Pump MakelModel ❑Floats dr ❑ Transducer
Tank draw down In/min Pump capacity apm Squirt Height ft '
a and
Pump on time Pump off time Daily flow set at
Upp,Y1g1a111
Mason County OSS Installation Report pg. 2 Parcel tt
ABANDONMENT RECORD
We existing septic components abandoned as part of this project? - - -- - - - -- -- --- - ❑ YES NO
War,
It yes,please describe:
wan,all components pumped out end property abandoned per WAC24e-272A-0300? - - - -- - -- ❑ YES NO
RECORD DRAWING
T6 la a pannanxe rtcard add moat W attune and dascdptNa enough to mJ .ta In the need to maintenance ad"tts and hro,*davNapm M TYOk PeW d
D.,as.man: DMnfuW a mantod odentaton&lapin Saptloryump ink I aton,WAhavow, oa.dnlnfidd,ealdhperd proposed Wading,la'sam d a'ar waYd'
wa..lq o,aanawW .;flan.eM ot",maintenance euaea pdnte, h I.toRecord DraMngs ivy e,eale additional delays in final Irulallalwn app al add rakkad pe,mia
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 aoccr-
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 clearedlapproved 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 iniormation 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.
2;I W 3 - I?-Z�
sig a inddWitt, Date
K fSyn H jr
Printeded N .Of Slg�n
c
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public °A
Health:
i
signature ofErnwironmentalHedilth specialist Date (stemp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Dp°e0itl¢ntagin
q
O m
� O
$|| O
§\
%/
k(§ e
§§§ ;
\ APPROVED
GPE 102
kj \ MASONCOUNTY EWRONYbA '
/§ � m