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HomeMy WebLinkAboutSWG2022-00370 - SWG As-Built - 10/14/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG aoa a • (No 3-7 o Parcel# 3daa'/-d 3- 9d081 Applicant Name (•AF1 mplpnq' - Subdivision (Name/Div/Block/Lot) Applicant Address P 6 boy- d7s; 17a City, State, Zip hir_IPg;V� u)G , 985r1 Installer Name 04 &W1,P0 Site Address q31- t1.- I-ldrd 8cl Designer Name loA/!rf-a INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pretreatment Type >5 ft.from foundation? ❑ NIA ®YES ❑ No 150ft.from wells? --- - --- - - ----- - - --- -- - ------ - ❑ M ❑ Z >50ft.from surface water? -- - - - -- -- -- - -- - - - - ---- -- ❑ © El fCleanout between building and tank? ---- -------------- - ❑ ® ❑ U Tank baffles present? -- - - -- - - - ---- -- -- - - -------- ❑ ❑ 6 24"access risers over each compartment?--- - ❑ ® ❑ LU N Effluent filter installed?----- - -------------------- - ❑ lip ❑ Septic tank size /20d gal Manufacturer O D-box water level and speed levelers used? -- ------4------- NIA ❑YES NO p0 Manifold/D-box accessible from surface?------- --------- - ❑ �J ❑ OQ Check valves installed? ----------- -------------- - ❑ ❑ 2 Transport Line Size a.n° Schedule/Class SCW c10 Bedrooms installed (check one) ❑-2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- ---- ------------------- - ❑ NIA ® YES NO >100 ft.from wells?- - - - --- --------- ------------- ❑ W >100 ft.from surface water? ---- -- --- -------- ❑ © ❑ Y. >10ft.from potable water lines?---------- - - ---------- ❑ ® ❑ Qz >5ft.from property lines and easements?---- - ---------- - ❑ ❑ OL > 30 ft,from downgradient curtain/foundation drains?---------- ❑ ® ❑ Drainfield level and observation ports present -- -- ---- ------ ❑ ® ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfeld?------------------ - ❑ q� ❑ Pump tank setbacks consistent with septic tank?------------- ❑ WA u}YES ❑ No Y Pump tank size_ 160C at Manufacturer ['6� rdo✓ Q24"access riser(s)and accessible from surface?--- ---- ----- - ❑ ® ❑ H a Alarm or Control Panel Installed? -- -- - - - - -- ----- ---- - - ❑ ® ❑ Control Panel equipped with Timer I ETM I Counter--- -- --- - -- ❑ IN ❑ a Pump installed in ❑ Bucket or ® On Block or ❑ Other a Pump Make/Model Lib< ?O ® Floats or El Transducer a Tank draw down 190 in/min Pump capacity y,7,`/�gpm Squirt Height 5O° ft Pump on time et.2 rL Pump off time YA Daily flow set at 36a apd Mason County OSS Installation Report pg. 2 Parcel# 1224-23-yre$I ABANDONMENTRECORD Were existing septic components abandoned as part of this project? -- --------- -" ' ❑ YES IS NO If yes, please describe'. ® Np Were all components pumped out and property abandoned per WAC240-272A-0300Y ---'-'-_- ❑ YES RECORD DRAWING .TN.I.a Inman..record and mug he accurate anh aescnpdan en..an ro n-luearo in ra•^••2 N mai.e^•^u-advwn and future jDMwmgAtt,�,"'hd 1 ItecoN ptnengs conbin:brai.reld&marvMd Garnallon 61ry4 Sapac anp lank buuort NaM ertwr,reserve dminfyN,edav,mb pmpoNO bnddlne�edinec,perml�s.® Recached CERTIFICATION OF NSTALLATIDN INSTALLER DESIGNER/ENGINEER 1 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 Codes. State and Mason County Codes I further certify that all information contained on this I further certify that all mformadon contained on this form a attac Record Drawing is accurate. form and attached Record Drawing is accurate. 9-s-Jdzy ignaturree of Installer Date Printed Name of Si nee MASON COUNTY PUBLIC HEALTH all 1� r The undersigned approves this Installs eport ,,• O/' '��I.NiHONV GafEHs tYEM jv qy��� Record Drawing on behalf of Mason Co. Is jy J 1 � �•_ YFI y.yn z'l Health: l0/8Y/7 SynamraofEnv/ronmenra/Hsa/rh Specva/is/ Date TA(NE4(Th, (stamp, 31;n8tu1ea7d610J THIS FORM MAYBE SCANNEDANDAVAILABLEFORPURLIC VIEW0,1 1HFY110NC0 UNIYWEBS/Tf deB*ta RECORD DRAWING continued ova �i� Rp 11gSONcovNry�N�roy g_&1w H1'lk vA q�P el I�:A SioO� bola / wle,spl Fkf - v 3 S'