HomeMy WebLinkAboutSWG2024-00265 - SWG As-Built - 9/16/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG Zo 2SA -ram Parcel# ZZ-( Z` S OOU lr1
Applicant Name S k a.t (v eQs A 6 rl Subdivision(NamelDiv/Block/Lot)
Applicant Address 7 n 1 O@9 e d o R K 1,•e.2 tl
City, State, Zip SE"O i lfmt-�u i.�q Yse t Installer Name R
Site Address 3 l t: V u/ . Designer Name -I w
INSTALLATION CHECKLIST �2
Fa�m
ll System Installation 0-rank(s)Only ❑ Drainfield Only ❑Repair ❑Other 1 l�
System Type +0 � Pretreatment Type 1�
ft. fountlatbn? --------------------------- �Wp �rEs ❑
.from wells? -_______ _____________________ ❑
R.fromsurfacewateR -______________________- ❑ 0 ❑nout between building and tank? ------------------- ❑ B ❑8 ❑baffles presen[7 -- -- -c m risers over each compartment?----- ----------- ❑- -
ent filter installed?-----------tic tank capacity(working) gal Manufacturer -4 r¢..G t a
Wit YES NOx water level and speed levelers used? ------- ❑ifold/D-box accessible from surface?-------- ❑ck valves installed? -----
.___________ _ _______
o< ttk Schedule/Claw_,,�'J
a Transport Line Size �y
Bedrooms installed (check one) ❑2 ❑3 ❑4 ❑5 ❑6 ❑Commercial101her
>10 ftfromfoundation?-------------------------- ❑ W° [ZYES
>100 R.from wells?-----------------------------
❑ ❑' ❑
W >100 ft.from surface water? ------------------------ ❑ B ❑
LL >10ft.from potable water lines?---------------------- ❑
Z >5ft.from property lines and easements?---- ------------ ❑ ❑
>30 p IL from downgradient cudain/foundatlon drains?-------- � Er-• 0 J1
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 fank7------ ❑ wn Er YES no
ZPump tank capacity (flood) 1 Z�� aai Manufacturer - 1-tray,+� w.— pr e_cRST
R 24'access riser(s) accessible from sudace7----------- - ❑� ❑g ❑
~ Alarm or Control Panel Installed? -- -- -- --------------•
a ❑ Er ❑
2 Control Panel equippetl with Tuner/ETM/Coumer----------
a Pump installed in ❑ Bucket or ❑'O n Block or ❑ Other
a Pump Make/Model ST,-T (- Floats or ❑Transducer
x 20 c m Squirt Hei ht
a
Tank draw down 1 /7 in/min Pump capacity P 9
Pump on time I IM 1 r\ Pump off time r S Daily Row set at 0 opd
uora.w azvmre
Mason County OSS Installation Report pg. 2
Parcel#
ABANDONMENT RECORD
YES NO
Were existing septic components abandoned as part of this project? --
If yes, please deambe: ❑ NO
Were all components pumped out and property abandoned per WAC24a272A-09O0? '---'--' ❑ YES
RECORD DRAWING
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wel4,obaNelFri WN,tleNoua,n4 oMx nuFlalerve iWfe%Iola. IncwnpMe ReruC Drawinge maY aeale iEUWneI tlelrye F Rwl InalaPs4011 appwdl MA relelaE
i
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
DESIGNERI ENGINEE76 ,
INSTALLER
I certify that I installed Me system in accordance with Ida Certify w�tthe septic deem has been OVED"by
the septic design stamped"APPROVED"by Mason
County Public Health and that any deviations shown Mason County Public Hviations
here have been cleamaVapproved by bore
th the designer shown
self and Mason Couapproere ham been d by b eeoth t alland Mason County Public Health and meet all Slate State and Mason Couny
and Mason County Codes.
Ifurther certify that all information contained on this 1further certify that all information cronfeined on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
_ 341/ sezo
Signature of installer Defe
foe t 1
Prinfed Name of Sgnee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
/�� �!1✓� ���zk
(stamp, signature and date
signature o/Environmental Health Spes"u"r Date ul�eB01=16
THIS FORM MAY BE SCANNED AND AVARABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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