HomeMy WebLinkAboutSWG2021-00684 - SWG As-Built - 9/18/2024 I
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC ALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2-024-006,?V Parcel # aO IF7 70wS-0
Applicant Name WA�p lh4AI1 Subdivision (Name/Div/Block/Lot)
Applicant Address A&C IVA 14 S6 tatty WO, 9FKV3 *101 CPA �74
City, State,Zip LAGOY WA 9�,f'03 Installer Name 5G0 4- 1 S-0A
Site Address UV 6P0141- L//i/Sdd Designer Name /i'dA/K hlL4fe/"
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Praff,(fP bp_l Pretreatment Type
>5 ft.from foundation? ------- --------- ❑NIA /E5 ❑ No
>50ft.from wells? ---------------------------- - ❑ lyi ❑❑
Z >50ft.from surface water? --------------------- -- ❑ rr-/
FCleanout between building and tank? - - ---------------- ❑ ❑
O Tank baffles present? - --------- ---------- --:---- ❑ ❑
IF 24"access risers over each compartment?---
= -- ---- --- ❑ ❑
yEffluent filter installed?------------ ------------ -- ❑ ❑
Septic tank size al urer 00tj P/4 /✓)
0 D-box water level and speed levelers
u Pb1 7S� NIA 1-1 vs ❑R
No
-box accessible from suac 11 M
OLL Manffold/D ro 29m 4= Check valves installed?
2 Transport Line Size Z Schedule/Clas Cd. 4 o
Bedrooms installed(check one) ❑ y fi ❑Commercial/Oth r
>10ft.from foundation?----- --- - - - -- - - ----------- ❑ NIA YIES ❑ No
G >100 ft,from wells?---- 1- --- --- ---- -- - ❑ ❑
W >100 ft.from surface water? ------- --- -- ----------- - ❑ L�y/ El
tL >10ft.from potablewater lines?--- --------- - ----- - ❑ p�Q/ ❑
a� >5 ft.from property lines and easements?- '--- , v --4---- ❑ BQ ❑
C' >30 ft.from downgradient curtain/foundatio rains? - ----- - -- ❑ ❑
Drainfield level and observation po prese ] El
❑ Graveless chambers or Clean grav sed? (check on
Proper cover installed over drainfield?---- ❑
Pump tank setbacks consistant with septic tank?------------ - ❑ NIA Eyees ❑ No
`1 Pumptanksize i3.010 gal Manufacturer n
Q24"access riser(s)and accessible from surface?-- ----------- ❑ ❑
~ Alarm or Control Panel Installed? --- --- ------ -------- - ❑ I� ❑
a
� Control Panel equipped ith Timer/ETM/Counter - ----- -- - - ❑ Ba ❑
7
d Pump installed in Bucket or ❑ On Block or ❑ Other �/
fL Pump Make/Model 1.j 6(.�}'y Z90 02 Floats or ❑Transducer
a (
Tankdrawdown '>ff in/min Pumpcapacity 43 opm Squirt Height 2;4- ft
Pump on time-Liffik-0-1nri(i Pump off time Daily flow set at 360 apd
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Mason County OSS Installation Report pg. 2 Parcel It
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? ---- -- - --- --- -- ❑ YES Ear No
If yes, please describe:
Were all components pumped out and property abandoned per WAC246-272A-0300? -- ------ ❑ YES n/d ❑ NO
RECORD DRAWING ��TT
This is a pe+mane d second and must be accurate and tleectlpllve enough b n-locab In the need of maim onanm a tivMea and Nome deveropmend. Typical RcoN
nmvingscontain: (trelnfield I manitddodenthonabyeN.SuAdpump lank Iomlbn,Norn avow,resenedialnned,dominated proposedbuidings,Icratunodwtllq thatnes,
cells,obou'den pens,domaouts,and other mainumarromucae pOlnla. Incomplete RemN OawbgsmrydraateidditlWelft.,In fi+al inalaltdo approve)ddrustedpernale.
Jf 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
here have been cleamolapproved 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 Drawing is accurate. form and attached Record D is accurate.
Signature Insfaller 9Date ts- i•s eI�'iy
SCQ4 ohhSi)n
.v
Printed Name of Signee "� r ' A`
sP. e
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and : AONrn,u�x�°upylT.e,�
Record Drawing on behalf of Mason County Public j 'H� II'9?�I :?`•'
Health: •
CrIem,
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLICVIEWONTHE MASON COUNTYWEB SITE upe.w dmrzo+e
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