HomeMy WebLinkAboutswg2024-00375 - SWG As-Built - 11/8/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWIG 2.0 y4 - 0o3 S Parcel#_y_;
Applicant Name ':DAIZJiJ (OGG Subdivision (Name/Div/Block/Lot)
Applicant Address PD `Dox 133 C,
City, State, Zip {-/J5®v$� VJA rFONO` Installer Name ,, glusti
Site Address N c, { W is r Designer Name a t{NauJ
INSTALLATION CHECKLIST O
❑ Full System Installation %Tank(s)Only ❑ Drainfeld Only ❑ Repair ❑OffW F 16
System Type -W Pretreatment Type O e-
>5ft. from foundation? —---------------- -------— ❑ WA ❑
>50ft from wells? - ___________________________ - ❑ ❑
Z >50ft. from surface water? ------------- ---
❑ ❑
HCleanout between building and tank? - --- --- `r ` _ ❑
V Tank baffles present? - -- - - - - - - - -- - -- --- P�cS ❑
1 24'access risers over each compartment?- - --------:J J.1124. '� ❑
W Effluent fitter installed?- -- - - - - --- -----
Septictanksize LU gal MorutacNtar '1`-T y" ia,Lo-Q r4(ddrl IVCYYCS
0 D-box water level and speed levelers used? --------- - ❑ WA ❑ YES ❑ No
gO Manifold/D-box accessible from surface?---------- ❑ �
QQCheck valves installed? - ------------------ - ❑ ❑ El
f Transport Line Size Sctedu
Bedrooms installed(Cheek one) ❑ 2 ❑3 04 ❑5 06 ❑Commercial/Other
>10ft. from foundation?-_________________________ ❑ WA ❑ YES No
C >100 ft. from wells?-____________________________ ❑ ❑ ❑
W >100 ft.from surface water? --------------
❑ ❑ ❑
LL >10R. from potable waterlines?----------- -_ ❑��B__
aZ >5 ft. from property lines and easements?----- - -- L7 JT ❑ ❑ ❑
R > 30ft. from downgradient curtain/foundation drake ---------- ❑ ❑ ❑
0 Drainfield level and observation ports present ----- -
❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Properwverinstalledoverdrainfield?-- - ---------------- ❑. ❑ ❑
Pump tank setbacks consistent with septic tank?------------- ❑ WA ❑ YES ❑ No
Z Pump tank size sal Manufacturer
24'access riser(s)and accessible from surface?- - --- -------- ❑ ❑ ❑
dAlarm or Control Panel Installed? - - -
f Control Panel equipped with Tim E f Counter -- ❑ ❑ ❑
O Pump installed in ❑ Bucket or ❑ On Block w ❑ Odw
a Pump Make/Model ❑ Floats or ❑ Transducer
f
0. Tank draw down in/min Pump capacity apm Squirt Height ft
Pump on time Pump off time Daily flow set at apd
uwec W'a e
Mason County OSS Installation Report pg. 2 Parcel# `f23/8 f/ - aj V C'
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -- - - -- --------- 'tits ❑ NO
B yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? ---- ---- YEN; ❑ NO
RECORD DRAWING
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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 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 furth ertify that all information contained on this I further certify that all information contained on this
form a r ed Record Drawing is accurate form and attached Record Drawing is accurate.
hoa 0flnsfaMer Date
7-A"ti )� da L3t'sz�/vs� s� c
Printed Name of Sgnee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
� I ( �31zy
Signature ofEnv6onmerdal HdaM Specialist Date (stamp, signature and date)
T M FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW 001 THE MASON COUNTY WEB SnE n°a°°bnrmte
RECORD DRAWING continued
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