HomeMy WebLinkAboutSWG2024-00405 - SWG As-Built - 10/22/2024 Masai County OSS Installation Report pg. I MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2J�A?y^ CC140'57 Parcel# 47.012' 'CDC,Z
Applicant Name MA49A R W Subdivision (Name/Div/Block/Lot)
Applicant Address Ia(pl2 -ems. C'k-04 A)t
City, State, Zip 4"ZACh V."A' 6115 Installer Name
Site Address 330 P.- ".WeWa46 fit"- Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation L Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other.
System Type C,,eA�c Pretreatment Type
>5 ft. from foundation? - --- - -- - - - - - ❑ NIA [gYES ❑ NO
>50 ft.from wells? - -- - - -- - - - - - - - - --- --- -- -- -- - ❑ ��,f ❑
2 >50ft.from surface water? - - - - - - - - - - - - - - - - - - - - - - -- ❑ ,n,,lr ElZ Cleanout between building and tank? --- - --- - - - -- - - - - - --
❑ L� ❑
V Tank baffles present? - - - - - - - -- - - - - - - - - - - - - - - - - - - ❑ ❑
a24"access risers over each compartment?- - --- --- - - - - - - - - ❑ [� ❑
W Effluent filter installed?- -- - - - - - - - - - - - - -- - - - - - -- - - - ❑ ❑
W 5
Septic tank capacity(working) I 2�00 gal Manufacturer o5
O D-box water level and speed levelers used? -- - - - - -- - - - - - - - 9 NIA ❑ YES ❑ NO
g J
O Manifold/D-box accessible from surface?-- - --- --- - - - - - - - ❑ ❑
mZ Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - -- ( ❑ ❑
oa
Z Transport Line Size Schedule/Class
Bedrooms installed(check one) ❑ 2 JA3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - - - - - - - - - - - - - - - -- ❑ NIA ❑ YES ❑ NO
>100 ft.from wells?- - - - - - - - - ia tS-n_v_+- ❑ ❑ ❑
W >100 ft.from surface wateR --- -- - --- - -- - --- - - - - - - - - El El
E >10ft.from potable water lines?- - - - --- - -- - -- - - - - - - - - - ❑ ❑ ❑
Z >5ft.from property lines and easements?- - - - - - - - - - - - - - --
❑ ❑ ❑
9 >30 ft.from downgradient curtain/foundation drains?- - - - - - -- - - ❑ ❑ ❑
G Drainfield level and observation ports present -- - - - - - - - - - - -- ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - - -- -- - - - - - - - -- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?- - - --- -- - -- - - ❑ NIA ❑ YES ❑ No
Y Pump tank capacity(flood) >orn
Manufacturer
Q24"access riser(s)and acce - --<E] r
LD
❑ ❑ ❑
SAlarm or Control Panel Insta - ❑ ❑
Control Panel equipped with - ❑ ❑ ❑
7
IL Pump installed in ❑ Buck o
IL Pump Make/Model Floats or ❑ Transducer
S
a
Tank draw down in/min Pump capacity opm Squirt Height fl
Pump on time Pump off time Daily flow set at gpd
upm,a emrzora
Mason County OSS Installation Report pg. 2 Parcel# NZIo2,-53—QCL
ABANDONMENT RECORD
Were existing septic components abandoned as pan of this project? - -- - - - - - - - - - - -- 1� YES ❑ No
If yes, please describe:
Were all components pumped out and property abandoned per WAC246-272A-03007 -- - -- - - - YES El NO
RECORD DRAWING
This is a y.nnaMm score and MM a,e«umla and ca.cn and annoi to naec.b In ms,road or malntanence aa•idas and rw,r.d—lopmeM. T,, l eemrd
Drawings mmaln Dalnfieda m.mm wlensadn a bpin.seodnpomp bnk"bon,darn snow reserve dralMrea,eaisgng and omWsen oonn" bcener w..en...,.�.rtinos.
wens,cL alion polls.tJeamue,end donor moiniereois atria Post4. Incanolote aemid orawinR my Draw edddimY oni F"inlal,soon aWmrai and related pemdLs.
[y 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 clearedlapproved 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 attache cord Drawing is accurate. form and attached Record Drawing is accurate.
KJ*
Signature of In Date
- iT1d +
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
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 u'dB1essaloo 0
t SWAGE SYSTEM CEHTIFICATIM
P[operty Dwner F ..� �'Y1��L Q Addreae
seweae conereetoe 'n k �� �.-J ➢ate Pareel(f
1,V cal N➢ f1'IANvR
3. Sce1e, 1 Sgoere . 10'
2. ➢raw in physical etrveturee to be on lot.
3. Show location of well or any body of water.
h. Stow location of aepl c ayetem In relationship to atmoture.
5. Assume an elevation of 'W' at one lot comer R indicate the otber lot orner
elevations in relation to it.
6. Use Arrows to chew direction of slope.
3
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2 c
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CSe�� G � z
rrm
ko b e
�zcorY��
Yl
Septic Ta Volume
➢ralofield [meth IV
L biu Yard- erevel used
I certify tout this system Se ]petalled ae ehewn above' end tMt el
mWireeents end etandalds of Thornton-Mason Health ➢iatrict lave
been satisfied. Siepetura
Gontreetor's Uceeue X �Ep
June..1970 V OCI o 2 2024
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