Loading...
HomeMy WebLinkAboutSWG2023-00278 - SWG As-Built - 5/19/2024 Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH c APPLICANT/PERMIT INFORMATION Permit Number SWIG -0 -3 -o"')-'l(' Parcel# -SB-oi°`L Applicant Name (11A1 Plv- -•J I C Sv-t Subdivision (Name/Div/Block/Lol) Applicant Address -614L A/w oLwor IY.O City, State, Zip Pr_se.. 0 163'70 Installer Name --P.'040w Site Address -Al Designer Name Aoo - Ne•.raf INSTALLATION CHECKLIST m Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type reatmenl Type kuIs 1 �-- >5 ft. from foundation? ---- - -- - r:i..,,L,+ml! \.-- -'.�i ❑ NIA ®YES NO >50ft. from wells? - __ _- - __ _ -__:._ _-_- ___ -- -- _ ❑ © ❑ Y >50 ft. from surface water? - - - - - ---- MAY ]91U14___,'-_ - ❑ ❑ ❑ HCleanout between building and tank? -------- ------- -- - ❑ © ❑ Tank baffles present? - - _ _ _ -- - _.1._._,,..�,�.,�-__ T ❑ a❑ ❑ a24"access risers over each compartment?---------------- ❑ 0 El W Effluent filter installed?- - - -- - -- -- --- ------- -- --- -- ® ❑ ❑ y Septic tank capacity (working) Imo° gal Manufacturer G D-box water level and speed levelers used? - -- -- -- - -- --- -- x❑ NIA ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- -- -- -- - -- - -- -- - - ® ❑ ❑ OP2 Check valves installed? - -- - - ---- - - -- - --- - --- --- - - ❑ © ❑ G< Z Transport Line Size 1 Schedule/Class 5,A •t° Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation?-- - - -- - --- - - -- --- - - -- - - -- . ❑ NIA OYES ❑ NO C >100 ft. from wells?--- --- --- -- - -- -- -- ----- - -- --- ❑ © ❑ W >100 ft. from surface water? -_ __ ___ _ _ __ _ _ _ __ _______ . ❑ ® ❑ i >10ft.from potable water lines?-- ---- - -- -- -- --- -- -- -- ❑ ❑ ❑ QZ > 5ft. from property lines and easements?- - --- ---- - -- -- - - ElEl❑x K > 30 ft. from downgradient curtain/foundation drains?- - - -- - - - - - ❑ ® ❑ C Drainfield level and observation ports present - - - -- - - --- - - - - ❑ © ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one N/A Proper cover installed over drainfeld?- --- - --- - - --- --- ❑ ® ❑ Pump tank setbacks consistent with septic tank?--------- - -- - ❑ N/A El YES ❑ NO Y Pump tank capacity (flood) 1�1 aal Manufacturer 24"access nser(s)and accessible from surface?----- --- -- -- -41 ❑ © ❑ ~ Alarm or Control Panel Installed? -- -- - - - -- -- -- - -- -- - -- ❑ ® ❑ 2 Control Panel equipped with Timer/ETM/Counter- -- - - - - - - - - ❑ ® ❑ IL _ Pump installed in © Bucket or ❑ On Block or ❑ Other a Pump Make/Model by ^^�••�n •.x.•f°Ft AJ ® Floats or ❑ Transducer f IL Tankdrawdown osu• in/min Pump capacity 3y apm Squirt Height a,A ft Pump on time -I sac_ Pump off time 3 Daily flow set at gpd Mason County OSS Installation Report pg. 2 Parcel# IL l - Z-01,— I ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - --- - - -- - - --- - ❑ YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - --- - - ❑ YES NO RECORD DRAWING This a a ham.n.m R[eN and must W accunds and E..ctlpava.mugh to moGa In the mad M mmmmnana aahmw and inure deminpment Typial Record Dmwings rageln'. Dminraw a mMdow dnenufon a laWq.Segx/pumpmnk loulbn,Nwm eimx,mxne drehnew,eaizlinB eM Pmpoead nulwliga,loaeon a walla.waterlines, "K.oEe w p ,cwanoW.and Nher m ilm wm aseaa mints. lnmm i Record Dmnngs my a a addhlunal delays in final Installation apoval and m41ed pmmaa. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I 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 Geared/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 1 further certify that all information contained on this 1 further certify that all information contained on this form at d attached Reccrd D wing is accurate. form and attached Record Drawing is accurate. Signehna oT r Date :.s It 111"i Sr ok4 �ornS�� r Pdnted Name o/S/gnee v ^••.�•,,,l�:ctf MASON COUNTY PUBLIC HEALTH ! J The undersigned approves this Installation Report and o:. ADAEd J.HUNTER Record Drawing on behalf of Mason County Public 1li`t'NSt"sJSF^1i3UE'R'`' Health: Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upd.t.e Informs | ~ | i D ,;E & � m - _/ 0 0 � § I , « \ � «» ) \ }/ / ; ° - ¢ . § \ � \ \ ( � � § \ § - \