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Home My WebLink AboutSWG2024-00220 - SWG As-Built - 12/16/2024 Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SVVG'LO — D0 Parcel# Zt IOSS%ooCSY Applicant Name Rtthavd L--Ir Subdivision (Name/Div/Block/Lot) Applicant Address Mtk E %Lr,4 t 6K Call City,State, Zip 6Eae%&ajQ WA y 46 Installer Name Eon 14e11Akj bt 1- Site Address l]10 E RensSnn l k Q1, Designer Name INSTALLATION CHECKLIST ❑Full System hablletion Tenk(a)only ❑Ominfiek only ❑Repair ❑Other System Type Pretreatment Type >5 it.from fo00dation? - -------------- --- --------- ❑ NIA 19YES NO >50ft.from wells? -- -- ----------- -------------- ❑ ❑ 2 150ft.from surface water? ------------------- ---- ❑ ❑ FQ- Cleanout between building and tank? ------------------- ❑ ❑ L) Tank baffles present? -- ----------------------- - - ❑ ❑ 1 24"access risers over each compartment?-------------- -- ❑ Cl Lu N Effluent fitter Installed?--------- ------------- --- -- ❑ ❑ Septic tank size %IILO gal Manufacturer 0 NIA O D-box water level and speed levelers used? -- -------- - -- -- ❑ NIA ❑ YES ❑ NO Manifold/D-box accessible from surface?------------ - -- -- ❑ ❑ ❑ eYZQ Cheek valves installed? --- - - --- ------------------ ❑ ❑ ❑ i Transport Line Size Schedule/Class exg Bedrooms installed(check one) ❑2 ❑3 ❑4 ❑ 5 ❑6 ❑CommerciallOther >10ft.from foundation?---- - - -- - - - -- ---- ----- -- - - ❑ wA ❑ yes ❑ No J >100 ft,from wells?-- --- ---- -------- - ------ ----- ❑ El El W >100 ft.from Surface water? -------------------- ---- ❑ ❑ ❑ ii >10ft.from potable water lines?------------- ---- ----- ❑ ❑ ❑ Q? >5 ft.from property lines and Settlements?-- --------- ----- ❑ ❑ ❑ d' >30 ft from downgradient curben/foundetion drains?--- ----- -- ❑ ❑ ❑ Drainfield level and observation ports present - ----- - --- -- -- ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) �( Proper cover installed over drainfiekl?------------- -- ---- ❑ ❑ Pump tank setbacks consistent win septic tank?- ------- ---- MNIA ❑ YES NO Y Pump tank size gal Manufacturer 24"access risers)and accessible from surface?- --- -- ------- ❑ ❑ ❑ RAlarm or Control Panel Installed? --------- ----- - ------ ❑ ❑ ❑ jControl Panel equipped with Timer I ETM I Counter- -- --- --- -- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other IL Pump Make/Model ❑ Floats or ❑Transducer ate- Tank draw down in/min Pump capacity opm Squirt Height ft Pump on time Pump off time Daily ft"set at gpd u�.werzvx�e Mason County OSS Installation Report pg.2 Parcel a Lt1 o'lSlooeS`l ABANDONMENTRECORD Were existing septic components abandoned as pan of this project?-------------• 50YES NO If yes. please describe'. Ipa Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- W YES ❑ NO RECORD DRAWING LAN U e gmunent Matt[nO thou b scunU[ntl 0w[rlpllve[muaM1 b n�xnU M YU n[[0 el m[Ntmenos e[gNM W hhn br[bpnmL T P ,Rw,n ba'A�PeovnW'MIMeYI d mWIOM uMnWNn 61epN$p�wpunp WY bUYm NnN Ynnw.nvn eeYNeb,eWYreN gPoeeW euPFPe,UulbntlxMe.weYrlM1e[. xNR oLnrvMm{al[.deeNwe,Yi0 oTetnniMenxM ews9 PdNf. In[uryMe PxaO dUNpYMY qYU eelliml Eelge In YW FMYMI epgWY UU n14aPUm'LL. II Record Orawing 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 Sol the sepb'c design stamped'APPROVED"by Mason dance well the septic design stamped"APPROVED'by County Public Health and that any deviatil shown Meson County Public Health and that any deviation here hem been daared/eppnved by both the designer shown hen have been c nH ct/approved by both and Meson CWlly Public FleSah and meet ea Stare myself and Mason County Public lieeah and meet all and Mason County Cordes. State and Mason CWnly Codes I fudqrcalmy that all information conte/ned on this /further rartiy that all Informeti CEWdRined on this !m a d all had cord rewing is accurate. _ form and attached RSWrd Drawing is aCcllrai9. vt Sig^^netur flnsalar Dom �M —Uq 1 of)goes MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Dewing on behalf of Mason County Public Hea th' V--I16(ZJ Signature^af Enomnmentel Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY Me WE aPYeaY Vlvm�e RECORD DRAWING mntlnued T N �y � u � J \ G � c W �L APPROVED MASONCOUDEC 16 2024 EmR pNMENTA(HEAITI RFT