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HomeMy WebLinkAboutSWG2020-00354 - SWG As-Built - 10/4/2027 i I Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG Z67-0 -O 0 Parcel# ISE -1,'1- 90,44 1 Applicant Name 1.Wt OA. Cl (S11'V� Subdivision (Name/Div/Block/Lot) Applicant Address 0 City, State, Zip qe M Installer Name L�IWlV P If1-N.frd. I .6lkI�- Site Address 'lr1-[1 &4 Sfij 12 G �a Designer Name ,�/ INSTALLATION CHECKLIST ttj Full System Installation ❑Tank(s)Only ❑Drai field Only ❑Repair ❑Other System Type Pretreatment Type >5 ft.from foundation? ----- - - ---- - --------------- ❑NIA Yes ❑ No >50 ft.from wells? ---------- ------------------ -- ❑ ,© ' ❑ Y >50ft.from surface water? --- -- ----- - - - ------ ----- ❑ L7 ❑ Z H Cleanout between building and tank? ------------------- ElL7 ,❑-✓ O Tank baffles present? - - -- --- -- ---- - - -- - -- - - ----- El 24"access risers over each compartment?- - ----- -------- - ❑ a W Effluent filter installed?------ - - - - ----- - ---- -- ----�- ❑ ❑ N Septic tank capacity(working) 1200 i al Manufacturer 1-IT< - 2 SrP}'ro'Icnits hx'k,1F11 0 D-box water level and speed levelers used? --- - ------- --- - ® NIA ❑YES ❑ No '0 Manifold/D-box accessible From surtace?---------- ------ - ® ❑ ❑ u. a?Z, Check valves installed? --- --- - -- ----------- ------ ❑ IR ❑ 02 Transport Line Size Zt, Schedule/Class se-11yb Bedrooms installed(check one) ❑2 ❑3 ❑4 05 ❑6 ❑Commercial/Other >10ft.from foundalion7-- ----- -- ---------- - ------ El NIA ® YES NO >100 ft.from wells?---------------------- -- ----- ❑ ® ❑ —t >100 ft.from surface water? --------- -- -- -- ------ -- - ❑ 10 ❑ W E >10 ft.from potable water lines?--------- ---------- -- - ❑ ® ❑ ZQ > 5ft.from property lines and easements?------- ------ --- ❑ 91 ❑ K >30 ft.from downgmdient curtain/foundation drains?------- -- - ❑ ® ❑ Drainfield level and observation ports present - - - --- ❑ ® ❑ ❑ Graveless chambers or a Clean gravel used? (check one) Proper cover installed over drainfield?------------- ------ ❑ '� ❑ 1 Pump tank setbacks consistent with septic tank?------------ - ❑ NIA ICRYES ❑ No Y Pump tank capacity(flood) f900 al Manufacturer HI3 2 Q 24" access riser(s)and accessible from surface?-- ---- --- ---- ❑ � ❑ r Alarm or Control Panel Installed? ------ - - - ----- ------ - ❑ ® ❑ a 2 Control Panel equipped with TimerIETM/Counter- - -- - -- --- - ❑ '® ❑ 7 C Pump Installed in ❑ Bucket or ® On Block or ❑ Other a Pump Make/Model 193 [A Floats or ❑ Transducer 0 Tank draw down 2 In/min Pump capacity 6 0 opm Squirt Height IS ft a Pump on time 7 Pump off time y 6915 Daily flow set at .Sr O _gpd Up Wd eavza+e Mason County OSS Installation Repoli pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of This Project? -_______ _ __ _ _ _- YES ❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-03007 -- - --- -- YES ❑ No RECORD DRAWING rThl. .p .mnt record 8M must b.accurate and d. .dpave oneogb to re-loctl.In the need of mdnlelnme ectivllbs eM fulum dsv]bDmaM Typbtl Record s tenbin:Mnelian�K,deanoYb,ertl ONer miiNev,[e ep¢ss gaMla. MUXxnp1010 Record DRwirga mayrfe]k Bddi4on01 delay9ln Mel imlaAilNn appnvdl]N rWletl D&mly ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 installed the system in accordance with 1 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 Codes. State and Mason County Codes I further certify 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. Sign Pure D/Installeer II Dale 10-e f ypN t 7�I1�W Printed Name of Signee MASON COUNTY PUBLIC HEALTH r3'or The undersigned approves this Installation Report and 2200010a Record Drawing on behalf of Mason County Public !gi]HI5A455St1.� '� Health: �Q �b 1L4 �� Signature of Environments Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE LpdeWW21/1010 z v n 0 z g z00 O z$ ow® , m L-----ESZ--J C r-----Py�u IIII IIII �,, IIIIQ o IIII I > IIII j 0 0 IIII I 00 O m w D �O R N m0 0 z m z � � O A r N I 0 aFm s 0 o � I �TO m O mF m 00, 9 Z Nmo O 2 m >`"O mOZ O � Caj ti $}r55��{�r R_ y O A �,mmz Om2mm 741OG1 � KO� CmD � O m � ra- � � T7 mIJANti CZn 05 pa � ❑ M M o z m ,am o m K y psi -mfm � DOz Om OZOOm mv � >Z um npZ 33210' D� z Z II O ti n K A\oil m Z ti v N y O D N Z -10 DRIVE m0 z 4 m m c r y -_-� x = p ❑ ,my s a N m I r I D m ' m 00 D S w > 0 I c m _ m mN O y O H N F 0 '.G3F.... L . 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