HomeMy WebLinkAboutSWG2021-00606 - SWG As-Built - 10/10/2024 OCT 10 2024
Mason County OSS Installation Report pg. 1 l3v MASOI I COUNTY PUBLIC HEALTH
APPLICANT/ P
FORMATION-
Permit Number SWGZU21 ' fj(OD(O Parcel If 22i "j2 - I ( - g0
Applicant Name V.MjLld �k)k trA PY iTIiZ Subdivision (Name/Div/Block/Lot)
Applicant Address 4 51 to S 254+ti S4.
City, State, Zip MCII}, W p Q Lb'�t) 2 Installer Name SVpxyt Malf S
Site Address QS\ e C7;bicy Lt) . Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation WrTank(s)Only ❑ Drainfleld Only ❑Repair ❑Other
System Type (11pen8on Pretreatment Type
>5 ft.from foundation? ------------ - - - - - - - - - - ----- ❑N/A .1YEa NO
>50ft.from wells? - - - - - - - - - - ------- --- --- - - - - -.- ❑ \Vr ❑
Z >50ft.from surface water? - -- -- -- - -- -- -- -- -- --- --- ❑ Qr ❑
H Cleanout between building and tank? -- -- - - - - - - - - ------- ❑ fer ❑r-��
V Tank baffles present? -- -- - - -- - - - -- -- -- - - - - - -- - - - ❑ 0 ❑
~a 24"access risers over each compartment?- - - - - - - - - ------ - El Z� El
W Effluent filter installed?----------- - - - - - - - - - - ----- - ❑ ❑
W
Septic tank capacity(working) 125Q gal Manufacturer 'Wed &LOEYMOS)
0 D-box water level and speed levelers used? ------ UN/A ❑ YES ❑ NO
00 Manifold/D-box accessible from surface?- - - ❑ ❑
00Z Check valves installed? - -- -- - - - - - - - -- - - - - - - - -- - -- ❑ ❑
OQ
f Transport Line Size Schedule/Class
Bedrooms installed (check one) P3 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- -- -- -- - - - - - - - - - -- - - - - - - -- ❑ N/A ❑ YES NO
G >100 ft.from wells?------------- - - - - - - - - - - - - ---- ❑ ❑ ❑
W >100 ft.from surface water?------------ - - - - - - - - - - - - ❑ El ❑
tL >10ft.from potable water lines?-------- - -- - - - - - - - - - - - ❑ ❑ ❑
aZ >5ft.from property lines and easements?- -- - - -- -- -- -- - -- ❑ ❑ ❑
K >30 ft.from downgradient curtain/foundation drains?-- -- -- - - - - ❑ ❑ ❑
Drainfeld level and observation ports present - - -- - - - - -- -- - - Cl ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - -- - --- -------- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?-- -- ---- ---- - ❑ NIA dyES ❑ No
Y Pump tank capacity(flood) 17.50 gal Manufacturer Trnf{i-( rnllPrA "QNry( OY)-
G24"access dser(s)and accessible from surface?-------- - - - -- ❑ ❑
~ Alarm or Control Panel Installed? - - - - - - -------------- - ❑ ❑
a
2 Control Panel equipped with Timer I ETM/Counter- -- -- -- - - - - ❑ ❑
IL Pump installed in ❑ Bucket or yJ On Block or ❑ Other ,1
IL Pump Make/Model Aj MCbtM\C1 ZW 50G Z.AP1 O Floats or ❑Transducer
f
0 Tank drew down 1-5 in/min Pump capacity 15 9pm Squirt Height ft
IL
Pump on time Pump off time Daily flow set at gpd
u0amd8Q1W18
Mason County OSS Installation Report pg. 2 Parcel u
ABANDONMENTRECORD
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-0300? - ------- ❑ YES 13,146
RECORD DRAWING
This is a pamumnt recong and mug ho a¢uraN and detonpllw enough to r aaokm in Na rwatl of malnYnanna a ttkfti a and Puna davalopmmtl. Typical RemN
Drawingscomme Dminfeld&manMob otienation&layout.5eplidWmptank IoreOon,NUN mww,msmx tlrain(Itl,eabling antl Ommsed buikinga.location Wwtlls,wetetliegs,
weMa,MaervWon poM ddrwub,eM a0er mYntenence ecceu pdnla. Inmmplde RemM Drawings may Mile addNmal delays in Anal usual pyovel crul neared pemin.
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 cleared/approved by both the designer shown here have been clearedfapproved 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 Gerrity that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
2
Signature of Installer Date
ShoAno MgpIP.S
Printed Name of Slgnee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
LILQQ�0'4M
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 tokaho""to"
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I APPROVE
NOY 2 3 2021
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APPROVED (J) 12W yau,„�
OCT 10 2024 .j�,� X jed
MASON COUNTY ENVIRONMENTAL HEALTH ��/ fd�r�L
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