HomeMy WebLinkAboutSWG2024-00356 - SWG As-Built - 11/8/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SyyG 7QZy- O03
5
6 Parcel# qZZ 103Zc 2.Z
+ Applicant Name (20h NN Ties$ e Subdivision (Name/Div/Block/Lot)
1 Applicant Address 27(P-] 5,*-w r Vjewy ,,��
City, State, Zip f�Gf Me 0e . 9�hS� Installer Name yco y ic_
Site Address Zo(4 /�! LK CDSHMfI. -M- Designer Name &XM NuI17
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Onl R
- y - ❑ Dminfieltl O ly Repair ❑1�-S7a+Q b /x
System Type r� /� fir---� atment Type Alo'N 4?—
>5ft. from foundation? --------------------------- ❑WA ffYEs NO
>50 ft.from wells? - - ---______ ❑ ❑
Z >50 ft.from surface water? •--___ _ ❑ � ❑
f Cleanout between building and tariff _ _______ - ❑ Elf) Tank baffles present? - - - - - ____ NQV 24-- __ ❑ ❑
R24"access risers over each -__ -___ __ ❑_____ 25 ❑
yEffluent filter installed?. - - - -____BY _ _ ❑ /
Septic tank size LO gal Manufacturer �lJS-t /�jy�{�S El
O D-box water level and speed levelers used? -_____________- ❑ WA ❑YES ❑ No
DO Manifold/D-box accessible from surta ? _ ___ ❑ ❑
OOZ Check valves installed? - - - -_ _ _ ___ __ ❑
f Transport Line Size gay
Bedrooms installed (check one) K,2 ❑3 ❑4 ❑S 06 1commerciaVOther
>10ft from foundation?-------------------------- ❑ 1eA No
>100 R from wells-, ----------------------------- ❑ rh. ❑
W >1001L from surface water?-_______________________ ❑ G� ❑
Z >10 ft. from potable water lines?--___________________. ❑ ❑
K > 5ft. from property lines and easements?---------------- ❑ ❑
>30 ft.from downgradient curtain/foundation drains?------ ❑ Cl
Drainfield level and observation ports present - ------------- ❑
❑ Graveless chambers or Clean gravel ued s ? (oh,*one) ❑
Proper ceverinstalled over drain?- ----- _____• ❑ .rsf ❑
Pump tank setbacks consistant with septic tank?------______ ❑ WA 'ryes ❑ No
Z Pump tank size jrJUC aal Manufacturer
F24"access riser(s)and accessible from surface?--- - -_______ . El
0_ Alarm or Control Panel Installed? -- - - - - - - - ------------
❑ ❑
Control Panel equipped with Timer/ETM/Counter- -------- - - ❑ hV- ❑
n' Pump installed in ❑ Bucket or n Block or ❑ Other
Pump Make/Model r <a Z ,C) Floats or ❑ Transducer
n
fl Tank draw down 2e S iNmin Pump capacity 52 apm Squirt Height -2 9 ft
Pump on time Pump off time r Daily flow sat at ZDO apd
wwmamrmu
Mason County OSS Installation Report pg. 2 Parcel If 4Z z to 3 Z !Uv Z 3
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? YES ❑ NO
+ ,yes, please describe-
Were all components pumped out and properly abandoned per WAC26 -03 ---- - - - - 0 YES NO
RECORD DRAWING
mu I5 a Mmrem t rec aft mlrsn Ee accanM aft Uri "Pl •aop98 m lo-bu@ m rift M d msYYnillp aciH1E55 aria fitOne ewebpmant TryW Remtl
lhvmBs mntam: lNanrreq 8 mm9oN aienlalron fl IeYaO,$eN-%Wmp tanM brallm.Nall,anax.tesave JaNwtl,eauM1q mtl V Wosea WNm05.brallon drelE,waleMes.
xells,opxaeMx tits,r16YM5,aW omc mam'enanre ac¢ys pools. Imm�plN¢Rmxtl nr✓ngs trey tlt M eptimllg Ul4rt/f FI noel n99atpn appmml bq remlM pmlilx,
A¢ Per 5.%5
'Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped•APPROVED°by Meson dance with the septic design stamped APPROVED-by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/appmved by both the designer shown hen:have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certii that al/informaton contained on this /further certify that ail information contained on this
forma et ach Record Drawing is accurate. form and attached Record Drawing is accurate,
SvAtW Installer Date
D /iGe.,,��
�i4iC/rd /
Printed Name of Signed
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and Aoasi+y nrsR
Hu y
Record Drawing on behalf of Mason County Public 'I FvAvf'U$iBNE'R""
Health:
�� It � h-Izy _
Signatt re of Envimnmentel Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Lpe5laCBrnrNte
77
@@@@ @@
` § ) §
� } � )
) �
a �
§ »
° 2 ¥
4
( O
@
( _
§ ) !
w,
, f `!
% w - 4 `6zt
(, o % k
{ §_ § \ (
\ / 2 § § ..
f � � } /�y \ >
- z
' . ` ,