HomeMy WebLinkAboutSWG2024-00284 - SWG As-Built - 9/16/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SwG 7M, 4 - 00 Z-� q parcel# 3%9//- S Z - ao i L
I /.
Applicant Name G.(.(�`(NG T-rJSLY,1146 bdivision (Name/Div/Block/Lot)
Applicant Address 2`{ c /tlF f-
City, State, Zip Kf ( Ip Ua Q°00 c( Installer Name Kro µ v S�
Site Address U0 S n rv, k-ii-+ Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation KTank(s)Only ❑Drainfield Only ❑Repair ❑Other
System Type 40i,Ar Pretreatment Type
>Sft from foundation? ______ _____________________ ❑ WA /p(ItyES ❑ NO
>50 ft from wells? _ ____________________________ ❑ ✓,rtX-'r El_ >SOft.from surface water? -_______________________ ❑ ❑
HCleanout between building and tank? ------------------- ❑ ❑
U Tank baffles present? - - - - - -- ------------ -------- ❑ ❑
a24°access risers over each cemparbnerrl't_______ _______
WEffluent filter installed ❑ El'7?- _ _ _ _ __ ___________ _________ ❑ ❑
Septic tank size //Z 5 o dal Manufacturer_. Wme �SBTtI�Q f
O D-box water level and speed levelers used? -_____________- Nat YES ❑ No
O0 Manifold/D-box accessible from surrr�ffaarrrnnne� .y� ,{-- ❑
GQCheck valves installed? - -- -- -K�/--1'_'G-___-TJl"C_ G�r(�r ❑ ❑
M Transport Line Size Schedule/Class //j—
Bedrooms installed (check ore) ❑2 ❑3 ❑4 ❑5 ❑6 ❑Commerciallother
>1Oft. from foundation?-------------------------- ❑ NIA ❑ YES NO
G >100 fl. from wells?_ _ ___________________________ ❑ ❑ ❑
W >100 ft from surface wataR------------------------ ❑ ❑
fl >10 ft. from potable water lines?-_____________________ ❑ El
Z > 5 ft from property lines and easement _
O 30 ft. from downgradient curtain/found�d --- _ _-7,.� ON- ❑ EEl
l
Drainfield level and observation ports present ----------T- , ❑
❑ Graveless chambers or ❑ Clean gravel ueed? (check ore)
Proper cover installed over drainfield?-- - - - -------------- ❑ ❑
Pump tank setbacks consistant with septic tank?----- --- -- - -- ❑ wA ❑ YES ❑ No
= Pump tank size gal Manufacturer
H24-access riser(.)and accessible from surface?----_________ ❑ ❑ ❑
a Alarm or Control Panel Installed? - - --
Control _ ❑
Panel equipped with Timer/ETM un - �} N /(/ / El
C
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
2 Pump Make/Model ❑ Floats or� El T sducer
p, Tank draw down in/min Pump capacity epm Squirt Height R
Pump on time Pump off tlme Daily flow set at apd
�bd+d verrzo+e
Mason County OSS Installation Report pg. 2 Parcel# C C
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - I-XES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246272A-0300? —O Fs NO
RECORD DRAWING
lllh b a grmanan[mcoy aM must le aaunb yq tl fli eve amuyh b mbcab b ma nay pr malnbnanu actrvlEes antl NNre darabpmem. Try Rt
Paglp¢ & SM.lankb im.N harox.2avva dayml0,1ii ,i-d PWured WiNa9s.ktlim dvMK wah ,
•eXc,oEselvnUm palls,tlaalmis.aM otlw n Imaue exe Punk. Inca *k,RttaE nlas0oay aeale s,J,W.laelaysn Ms!nslAs"appavelatl billy W Ms.
�Z
_ ) F
n � G
�3
� ❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
1 certify that 1 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/appmved 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 I further certify that all information contained on this
fol�&fo e d ett Record Drawing is accurate. ,f form and attached Record Drawing is accurate.
Record Ons s oflnstalnler ^/,, �(�f Da
Printed Name of Slgnee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behaKof Mason County Public
Health:
Signature OAErmronmen I Health Specialist Date (stamp, signature and date)
TNIs roew i4Ay ee sCANNEDANDAwu ABLE Fore puBLIC ,EW ON TrE LwsON COUNTY wEe srTE wem somas