HomeMy WebLinkAboutSWG2022-00511 - SWG As-Built - 11/4/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SIN`O...tlG 2.0'L•/L/��� �((-�+ Parcel li sl 9O`o-rm• �bUA2
Applicant Name rv�aA `l o�J�'�t-� Subdivision (Name/Div/Slock/Lol)
Applicant Address t �,� �p���� 1\� � � �
City, Slate.Zip II II 1 dd-LJYS2 p( Installer Name TVA1�-c A[74 Cr)
Site Address U Wgcioop Or Designer Name
INSTALLATION CHECKLIST
�t Full System Installation ❑Tankls)Ony ❑Orainlield Only ❑Repair ❑Other.
System Type Pretreatment Type
>5 ft.from foundation? - -- - --------- -- -- ---- --- -- ❑NIA Es ❑ NO
>50 ft.from wells? - - - - - - - -- -- -- - --- ---- - ------" ❑ ❑
Nc >50 ft.from surface water? -- -- ---- - - ---- -- ------- ❑ ❑
2
Cleanoul between building and lank7 ---- - - - ------------ ❑ ❑
U Tank baffles present? - ---- ------ - - - ----- -------- ❑ ❑
a
24`access risers over each compartment?- --------------- ❑ ❑
W Effluent filter installed?- - - - -- - -- -- - - ------------- - ❑ ❑
N
Septic tank capacity(working)L 7-rSjj gal Manufacturer r�
g D-box water level and speed levelers used? -- -- -- - -- ----- - L+y,,,,(NIA YES ❑ NO
00 ManifaldlD-box accessible from surface?----- ----------- - �❑'y ❑
'xti
G<EL Check valves installed? - - -- ------- - --- --- -- ---- -- ❑ El
2 Transport Line Size Schedule/Class fc Af yU
Bedrooms installed(check one) 2 123 ❑4 ❑5 ❑6 ❑Commercialf0lher
>10 ft.from foundation?-- - ---- ---- ----- ---- -----' ❑ NIA YES ❑ NO
>100 it.from wells?- - --------------------------' ❑ ❑
d >100 ft.from surface water? ---------- ----------- ❑ ❑
W ❑ ❑
a >10 ft.from potable water lines?---- ---- ------------- '
2
Q >5It, from property lines and easements?- - - - --- --------- ❑
K >30 ft.from dowagradienl curlsin/foundation drains?------- ❑ ❑
O Drainfield level and obsewslion ports present - -- -- - --------- ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?---- - ------ -------- ❑ ❑
Pump tank setbacks consistent with septic tank?------------ - ❑ NIA Ips Yes ❑ No
Y Pump lank capacity(flood) �� gal Manufacturer
2 ❑ ❑
Q 24"access risarls).and accessible from surface? ❑
---_ -
D. Alarm or Control Panel lnslalled7 ------- -- -' ----- ❑
Control Panel equipped with Timer I ETM I Counter- ---- --- - ❑ % ❑
a Pump installed in El Bucket or �On Block or ❑ Other
o' Pump Make/Model �t-Ot�O`C I`; be15 Or ❑ Transducer
D.
Pn
a � r1-�
Tank draw down it Pump capacity gyL-9Pm Squirt Height ft
Pump on time� Pump off time Daily flow set at ND gptl
Mason County OSS Installation Report pg. 2 Parcel a
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? ❑ YES ❑ NO
RECORD DRAWING
TMs le a Derm.nt neo.tl antl motl be eaurale end*—Idfee—,h m n'Imete In IM1e nod pl montewnm eniiMMln and(.tort tlrvebpmenL Tryinl Ww.d
0'dnv55...n D's'"a 6 r,sra.d r...1on&.p,s,nivp,tank tocvon.Nann a no.me .dcxnsio,seisenp and pmpasM bad nis son on owells,eattNnes
elu.o.nrva,o.+.me nuneusaanlm.—le—ceactinio'.nLL. Incomplete R—rdD—le mq create edo—1 di. m bmLnNlWan epp'avel nndecled wine
I
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
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 1 further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
o p114
P Date
SignafYre ollnsteller
Joe,�uw � � ii/f/�t
Ponied Name of Signee
4}i .nsi
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and ;b deeded,
.......1@ ) R ...-
Record Drawing on behalf of Mason County Public Ic
Health.
��
Signature of Environmental eatlh Speciatim Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE dpdoxd,ore,:e
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