HomeMy WebLinkAboutSWG2024-00294 - SWG As-Built - 11/12/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number Scc��WG 211 2-�"- Mlgl-4 Parcel# 3 ti o1-so - oaoso
Applicant Name NYI'Ad L4b"" Subdivision (Name/Div/Block/Lot)
Applicant Address 3cS14 !-k(,r bn V ie
City, State,Zip axN ty ta, WPt C?krR\ Installer Name Q�
Site Address � Designer Name
ny, INSTALLATION CHECKLIST
Lyy Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
l_ System Type Pretreatment Type 1
>5 ft.from foundation? ---------- /�I�rr A}ry�- - ❑NIA YES No
>50 ft.from wells? ------------ IIVV'125} IVI tCyI/'IIyS ❑
Z >50 ft.from surface water? ----- -- - ❑ ❑
FCleanout between building and tank? -- AX 0 i2i- ❑ ❑
V Tank baffles present? - - -- - -- -- - -- �Af1//�jj�_IIIy�RI ❑ ❑
d 24"access risers over each ximpartme Y�- _--_- ❑ ❑
W Effluent filter installed?------- ------------------- - ❑ ❑
41
Septic tank capacity(working) al Manufacturer kAI)% pC2 V
O D-box water level and speed levelers used? -------------- - [%WA ❑YES ❑ No
a0 Manifold/D-box accessible from surface?---------------- -LA-
[9� ❑ ❑
m= Check valves installed? -- --- -- --- - --------------- ❑ ® ❑
ca a
f Transport Line Size 2 Schedule/Class SC�
Bedrooms installed(check one) P2 [33 ❑4 ❑ 5 ❑6 ❑CommerciallOther
>10ft.from foundation?-- -----`------------------- ❑ NIA MYES NO
>100 ft.from wells?----------------------------- ❑ ❑
W >100 ft.from surface water? ----------------------- - ❑ ❑
E >10ft.from potable water lines?--------------------- - El ❑
Z >5ft.from property lines and easements?--- ------------- ❑ ❑
Q
K > 30 ft.from downgradient curtain/foundation drains?--------- - ❑ ❑
Drainfield level and observation ports present -- ------ ------ ❑ ❑
❑ Graveless chambers or [M clean gravel used? (check one)
Proper cover installed over drainfield?------- ------------ ❑ ❑
Pump tank setbacks consistent with septic tank? ------------ - ❑ WA,l� YES ❑ No
Z Pump tank capacity(flood) IZ� qat Manufacturer Vtd �Qz4Ak
24"access riser(s)and accessible from surface?------------- ❑ Elg
6 Alarm or Control Panel Installed? ----- --------------- - El ❑
f Control Panel equipped with Tmer/ETM/Counter- --------- - ❑ � ❑
Il Pump installed in ❑ Bucket or ® On Block or ❑ Other
Pump Make/Model 161641 co SO [.Floats or 'I Transducer
II �
a Tank draw down 2 in/min Pump capacity 5 0 gpm Squirt Height ,q4- ft
Pump on time rn:n Pump off time Daily flow set al 2q0 gpd
U%ixa Brzv]0'B
Mason County OSS Installation Report pg. 2 Parcel
ABANDONMENTRECORD
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
Ind.Is e parmamnt ncoM and muff W eaurete and afctlptive enough to n.locab in the need or mamenance anlvulea and Ntuee development Typcal aewrd
.nevargawrNin. entree.8mvniWgoryntldon64pm.apnliump unt ioo'ron.Wcn erm%o.reaerv<durfid..axiating and pmpofM huild'ngs boaton or ro11 ,w rM1n-s
wa14.CDNmllon Ibr4.tluMu4.ecd oNNmem4renG e¢aR pynrs. Inranpk'n RecON OraWy6 miy Odire addlWrNl dNays in Orlal muNrwn approval an]related permits.
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI 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 further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
10 I24
SigIfatum oflnstaller Date
Joe. flouJx �� `s, n161ti
Printed Name of Signee $ +?,
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public ;• ADACtsr u. 111'-HUNTER `.
Health: L101'FUP. nKsiiiVf;f"`
?ticcsac�m,.�-
( �
Signature of Environmental Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE wd4.a n+rm+e
§ , ` —
,
| �
\ 2 �
i
/ t
0
k §
\ f
` /(
, q ! /
;
! / /
« \
\ � \ ; �
% �
| § 7 � a } j § | (
- (\ q ° ` -
) \ � 2/ ) § +
| ]y
~ § { )
§ ® k
\ | § F | � � %