HomeMy WebLinkAboutSWG2021-00316 - SWG As-Built - 9/18/2024 Mason OSS Installation Report pg. i MASON COUNTY PUBLIC HEALTH
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AI/PVyPLLIgI1C��A++NT/ PERMIT INFORMATION
Peunil Number Mwl 2 ((��W AG
Applicant Name $ Ft{?,=Cg 1�1�' Subdivision (Name/0101100&01)
Applicant Address 8S%f SAeb IK4�tp�//hl
City, Slate, Zip L., wA. W.1 4 1)13 Installer Name L -+r.- ^r �+• _.
Site Address t l ze l y W, Designer Name /h
�.,/' INSTALLATION CHECKLIST
Ly mull System Installation ❑ lank(S)Only ❑Dmmheld Only ❑Repuu ❑01hw
System Type j;U51.✓'C. 6l W 04-1 Pretreatment Type_ 4 21 _
>5ft from foundation? - -- - - - - - - - -- - - - - - - - - - - - - - - . ❑ NIA ❑ NO
>50 ft. from wells? -- - - - --- - - - - - - -- - - - - - - - - - - - - ' ❑ ,y� ❑
Z >50111 from surface water7 - - - -- - - - - - -- - - - - - - - - - - - ❑ IYJ ❑
Cleanout between building and lank? . - - - - - -- - - -- - -- - - - - ❑ [� - ❑
U Tank baffles present? - - - - - - - - - - - - - - - -- -- - -- - - - - - ❑ � ❑
H- 24 access risers over each compartment?- - - - - - - - - - - - - - - ❑ ,�,( ❑
WEffluent filter installed?- - --- - - - - - - - - -- - - - - - - -- - - - - ❑ WJ ❑
/5 3 0 1..L4 ya4n/o/
Septic tank size gal Manufacturer �/
o D-box water level and speed levelers used? --- - - - - - ---- - - rLJ NIA ❑ YES ❑ NO
p0 Manifold/D-box accessible from surface?-- ----- - - - ---- - -- ❑ ,I-r�� ❑
mZ Check valves installed? - - - - - - - - - -- - - ----- -- - -- -- - ❑ YJ ❑
OQ
Transport Line Size Z Schedule/Class `!�
Bedrooms installed (check one) ❑ 2 ❑3 4 ❑5 ❑6 ❑Commercial/Other
>1 Oft. from foundation?-- ------- -- - -- - - - - - - - -- - - - ❑ NIA �YEs El No
>100 ft. from wells?-- - -- - -- --- ---- --- - -- --- - - - - ❑ I!r ❑
w >100 ft from surface water' - - --- -- -----------------
❑ ❑
a >lof from potable water lives?-- - --- -- - ----- - -- - --- ❑ IPf ❑
Z > 5 ft from property lines and easements?-- -- - - -- ---- - - - - ❑ ❑
> 30 ft.from downgradient curtaindoundabon drains?- - - - -- - - - - ❑ El
Drainfield level and observation ports present - - - - - -- ---- - - - ❑ IYJ ❑
2!(Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?--- -- -- -- -- -- - - -- - - ❑ ,El ❑
Pump tank setbacks consistent with septic lank?- -- - ----- - - - - ❑ NIA Er YES ;; ❑ No
`d Pump tank size {00 at Manufacturer ,.,/
Q24" access risers)and accessible from surface?-- - - ---- - - - - - ❑ Iif ❑
~ Alarm or Control Panel Installed? -- -- - - - - -- - -- - - - - - - - - ❑ 07 ❑
2 Control Panel equipped with Timer/ETM ❑(Counter-- - - - -- - - - -
C� ❑
°• Pump installed in ❑ I�fBucket or On Block or ❑ Other ,�,/
a. Pump Make/Model d+r f Y 290 D Floats or ❑ Transducer
F 6,0_ r
a
Tank draw down 1•S rr in/min Pump capacity�gPm Squirt Height�ft
Pmnp on time Pump oft time O�00'00 Daily flow set at 3 gpd
uw.w .o,min
Mason County OSS Installation Report pg. 2 n a
ABANDONMENTRECORD
Were existing septic components abandoned as pad or this project? -- - "-- - --- - - - - - ❑ YES lK NG
It yes, please describe.
Were all components pumped out and property abandoned per WAC246-272A-M7 '" " " """' ❑ YES ❑ NO
RECORD DRAWING
TM.w.learra.nwa nand add rlxm W accurate and nanlpaue enough to mina. In the need or maintenance atlnnles and future d"Olonnew. -VD"f .
mr.'ae0e gran Q.Mew6marrow nxv9alxnAbYow SeplaWmplankhra4on,NMnmmw.r—Nedmnneln.euslnd,x,d wowedInuMmps WAN MwKware
welk_epfwYMkT kVrle UetlKYIs,wM ONef manlMdMC OcceU pJinIB IrcgnpMleftrvrvp Ormwr{Ie maY UeMe.MJ.Ixmd Mlryenlmar nalanalm app'+vnl and rnlnrH:^"'
r� Recortl Drawing Attachetl
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 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 Cafes. State and Mason County Codes
1 further centiry,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
Sf�P<-- 5<:ray
Pnnted Name of Sign"
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health
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 0p0V11- -
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