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HomeMy WebLinkAboutSWG2023-00239 - SWG As-Built - 11/1/2024 /lnrE�r.doff-}Ic.nd pmn ie go'.na mv'r�f. �e^"�•idiLeyS®3"'4il .Coy./.. d e 6 391-75ot Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number BINGao ;Z3 -00a39 Parcel# 37723-75- 9�z1 Applicant Name FwR t W;,gaj Subdivision(Name/Div/Block/Lot) Applicant Address P6AAj A7:5 to tilt klQAnQ r Adz QPl�PA `P - City, State, Zip &149a1r 1,7aSfn.985a9 Installer Name A.Z;P,1cf1e Site Address 10 K7&bq40 Designer Name 1� 9' rr7 INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑Dminfield Only ❑Repair ❑Other System Type Pretreatment Type >5ft.from foundation? --------------------------.- ❑MIA YES NO >50 ft.from wells? ------- ------------ "--------- - ❑ ® ❑ Y >50ft.from surface water? --- - -------------------- ❑ ® ❑ z r Cleanout between building and tank? ------------------ - ❑ ® ❑ O Tank baffles present? -- -- -- --- ------------------ ❑ . ® ❑ a24"access risers over each compartment. ---------------- ❑ © ❑ rW Effluent filter Installed?--------------------------• ❑ M ® ❑ Septic tank size 1WI gal Manufacturer a D-box water level and speed levelers used? ------- ------ ® MIA ❑YES NO 0J 0 Manifold/D-box accessible from Surface?----------- ----- - ❑ ❑ a0Z Check valves installed? ------------------------- - ❑ ❑ oa 2 Transport Line Size a•O Schedule/Class S&H W Bedrooms installed (check one) ❑ 2 1M 3 ❑4 ❑5 ❑6 ❑Commercialfother >10ft.from foundation?----------- -------------- - ❑ wA ® YES NO Q >100ft.fromwells?----------------------------- ❑ I ❑ W >100 ft.from surface water?------------------------ ❑ © ❑ M >10fL from potable water lines?-------------- ❑ ® ❑ Q? >5 ft.from property lines and easements?--------------- - ❑ ® ❑ OC >30 ft.from downgradfent curtain!foundation drains?---------- ❑ ® ❑ 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 vas ❑ No Z9 Pump tank size food at Manufacturer t I V a 24"access dser(s)and accessible from Surface?------------ - ❑ 11 ❑ H 4. Alarm or Control Panel Installed? ------ - ------------- - ❑ Control Panel equipped with Timer I ETM/Counter----------- ❑ ® ❑ d Pump installed in ❑ Bucket or ® On Block or ❑ Other gPump Make/Model 11/icrIg 44 ®Floats or ❑Transducer M Tank draw down at0 inimin Pump capacity 'W,z5 apm Squirt Height _ft Pump on time d.6/{ Pump oft time rs- Daily flow set at 36t gpd ASon County OSS Installation Report pg. 2 Parcel p 3 a&- -75- 9b -I1 ABANDONMENTRECORD Were existing septic components abandoned as part of this project? --------- ----- - ❑ YES ® NO If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A.0300? ---- - --- . NO RECORD DRAWING .This is.p•,mn.nt nwrd add must w accupde and a.urtstoa susn to rt-I•..e i.rn•n..a m mm.•••... toiu.••.e Muse ae empment rypou Rewm onsom,mMs.. am'vLlb d menMd MenmMn 61rypu1,Septiclµmplank Ioce4w.NpM amm+t merve dminfiNd,er:ie11n08M prpWeed OYiIEln9s,bW Wn pf wMY,vniartinee. wNs,cbetl.aAdnppb,deenwb,atl pllwm®menvm•ecrmappinb. Incpnplele RamJ Ornui�ga mryvMadBtlmel Meye lnf Iinsialktipn ippmvel and,e101M permi's. g Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/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/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 an this I further certify that all information contained on this form and Site Record Drawing is accurate. form and attached Record Drawing is accurate. � Signature of Installer Date Date Printed NaMir of Signee .....y MASON COUNTY PUBLIC HEALTH � The undersigned approves this Installation Report In ra a.dmzs fi' no O.E.Y pEfdIERO Record brewing on behalf of Maso �unty Pu61� I - i N Health: 'vCD� vYY v�J 1.0J �." srgnerure wEnvimnmenra/ ea/rh Spadalist Oa 4 NFN �Slamp, 9;1191ure an MP) 'MI5 FORM MAYBE SCANNEDANDAUAILABLEFORPUBLIC V/EWON THEN480N00NN7WE8SZ 4li�E'�����8 RECORD DRAWING continued I /Jo7F: 7Ar Dr6:.+l'rJ2 ms das;0rv�j Yk Sys lcN 1io a639 u%� p 4 q,,,✓u uJf r:ss [m�iiolS I 1 NETr'R yfr Sx,AIE 1n--s6 go 00 <H' r APPROVED t' NOV 0 1 2024 MA31 4 COUNTY ENVIRONMENTAL HEALTP DJA