HomeMy WebLinkAboutSWG2024-00324 - SWG As-Built - 12/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SwG2c31,4 - O032-LI Parcel# 3u37 5 - 50 -cx3D'56
Applicant Name (hnvleS A Lgp%O 111c{2CUnn&Subcivision (Name/Div/Block/Lot)
Applicant Address JAC) LJ ChUnnel 4. %A.
City, State, Zip CholttyYlrll A Q $Q) /AL4 Installer Name me M6011pS
Site Address NO SE C han"..I Qt .9-0 - Designer Name 01
INSTALLATION CHECKLIST
❑ Full System Installation Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other %
System Type 'Pi Pretreatment Type
>5ft.from foundation? --- - - - --- -- - ---- - - ------ -- - ❑ NIA ❑YES El IN
>50ft.from wells? . - ---- - ----- - - ----- - - ---- - ---- ❑ ❑ ❑
2 >50ft.from surface water? - - - - - - -- - -- - -- - - - - - - - --- ❑ ❑ ❑
fCleanout between building and tank? - ----- - ------ - ---- - ❑ ❑ ❑
C.1 Tank baffles present? - - - -- - - - - - -- - -- - -- - -- - -- - -- ❑ ❑ ❑
F- 24"access risers over each compartment?- - - ---- - - - ---- - - ❑ El El
UJI N Effluent filter installed?- - - - ---- - - ---- - - - ---- - ------ ❑ El El
Septic tank capacity(working) dal Manufacturer
r3 D-box water level and speed levelers used? - -- - - - --- - - --- - ❑ N/A ❑YES ❑ NO
RO Manifold/D-box accessible from surface?---- - - - ----- - --- - ❑ ❑ ❑
IPz Check valves installed? - - - -- - - -- - - - -- - - - - - - - - - - -- ❑ ❑ ❑
04
2 Transport Line Size Schedule/Class
Bedrooms installed(check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?- - - - - - -- - - - -- - - -- - - - - -- - -- ❑ NIA ❑ YES ❑ NO
C >100 ft,from wells?- ----- - - ------ ---- - ------ --- - ❑ ❑ ❑
W >100 ft.from surface water? . ------ - ----- - ----- - ---.- El ❑ ❑
LL >10ft.from potable water lines?- - - - ---- - ------ - ---- - - ❑ ❑ ❑
aZ >5 ft.from property lines and easements?- - - - - - -- - - - - -- -- ❑ ❑ ❑
K >30 ft.from downgradient curtain/foundation drains?- -- - -- - - -- ❑ ❑ ❑
Drainfield level and observation ports present - -- - --- - -- - --- ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?--- - ----- - - ---- - - - - ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?-- - - ---- - - --- 841A ❑ YES ❑ No
`L Pump tank capacity(flood) 5-0e at Manufacturer Fo ftn
G~ 24"access risers)and accessible from surface?---- - - - ----- -
Ala" or Control Panel Installed? ------ - ---- - - - ----- - --
❑ ❑
❑ ❑
a
� Control Panel equipped with Timer/ETM/Counter- -- - - - - - - -- ❑ (S ❑
a
Pump installed in ❑ Bucket or r g3�/On Block or ❑ Other
CIL Pump Make/Model_S�t�15 P AP Floats or ❑ Transducer
d Tank draw down in/min Pump capacity apm Squirt Height ft
Pump on time Pump oft time Daily now set at dpit
Ilpamtl bR11A1B
Fwlf,es.
on County OSS Installation Report pg. 2 Parcel If
ABANDONMENT RECORD
re existing septic components abandoned as part of INS project? --- ----- ------- ❑ YES ❑ No
please describe:
Were all components pumped out and property abandoned par WAC246-272A-0300? ------- ❑ YES ❑ NO
RECORD DRAWING
111Y b w�me cam.nd muu se eccmm and dYUYllw enwab m mawae In Ito nmd a menenenvm WON*are talum dewle,—nL TMW Mewl
UrxrYee¢nYN^pmlMega me Wall wknlsLLaid Yywl aepwNnp lento leraLW..Nuai YLw, uns OLNMp,aMWgwepgmW wNNyr.bulan alnW.MWMN.
W4,aLeOmdWYIpW.LbYW1Y,Vd WW mw1110'unw%wuplYa NwyMbY RamN CmwMrema/pNYMdawW ddYy.In MNINI..p NeM)Nam wlMa.
O �V
7
AFC I1pZt
�O
16ecord 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 boon cleamaVapproved 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 c rtury 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 wounds.
�i I bl11
Stgnefure of InslelMr Dale
5rohe �nl�ier �� ,
Printed Neme o/Slpnae - � '
' I I
MASON COUNTY PUBLIC HEALTM4S0N UFC {/�O
The undersigned approves this Installetlon and
Record Draw on ba a/fOf Meson County Pit B,ypf �QZy
Health.- / p�Roy
Signature ofEnvlm meMei Health Specklial DAN (stamp,signature and date)
THIS FORM MAYBE SCANNEDANDAVABABLE FOR PUBLIC VIEWON THE MASON COIINTYINESSITE a^°^'danln°ie
i
V
r "
L
4
9
"o
S
APPROVED T APPROVED
DEC 1 1 2024 VAS JUL 30 2024
MASON COUNTYENVIRONMENTAL HEALTH ONCOUNTYENVIRONMENTA HEALTH
DJA RET
4
ri
f
w
ti