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HomeMy WebLinkAboutSWG2020-00065 - SWG As-Built - 12/10/2024 I • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2020-00065 Parcel# 222145000004 Applicant Name JEANNE BALLOT Subdivision(Name/DW/Block/Lot) Applicant Address 7928 LAKE VIEW LANE City, State,Zip MERCER IS.98040 Site Address 16581 E ST.RT 106 Installer Name FINAL VISION INC Designer Name JIM HENRY t INSTALLATION CHECKLIST ❑Full System Installation ®Tank(sI Only ❑Dralnfleld Only Repair ❑Other System Type -L- Pretreatment -- >5 t.from foundation? -_____ Type BIO B=_ _______________ ❑N/A ®YES ❑ NO >60fl.from walls? .__________________ ❑ Z >50k.from surface winter? ,______________________. El ® . F Cleanout between building and tank? ------------------ - ❑ ® ❑ , U Tank baffles present? .__________ ❑ ® ❑ Q. access risers over each compartment?•________ ❑ ® ❑ Y ❑ ® ❑ N Effluent filter instelledl P Y( g) el Manufacturer ❑ EVERGREEN PRECAST Septic tank caacit workln 1200 ❑ ' �o O-box water level and speed level9m Used? ._____________ OO Manifold/D-box accessible from surface?----------------- WA ❑vas NO maZ Check valves installed? ---_________ _ __ ® ❑ ❑ E Transport Line Size Schetlule/Class ❑ ❑ � • p Bedrooms Installed(check one) ❑2 >10ff.from founds tion7---------__A o ❑4 ❑5 ❑6 ❑Commamial/Other p >1Qo ft,from welts?- _ ___ Q NIA ❑YES ❑ NO W >100ft.from sudaceweter?-____ _______________. © ❑ ❑ 2 >10ft.from potable waterlines?•--------------------- ❑ ❑ Q >6h.from property lines and easements?-___------_____ ® ❑ ❑' R >S0 ft.from downgredlern curtafin/foundation drains?--_______, ® ❑ ❑ Drain6eld level and observatlon Ports present ----________ © ❑ ❑ ❑ GreVeless chambers or [I Clean gravel used? (check one) El ❑ ' Proper cover Installed over dreinffeld?------------------ - Pump tank setbacks consistent with sapfic tank?..........__, ® ❑ ❑ Y tank ca c ❑ WA ® ❑ No Pum Z P pa city(flood) 1200 cal Manufacturer EVERGREEN PRECAST H 24"access risers)and accessible from Surf ..?-___________ Q. Alarm or Control Panefinstalled? -------------------- ❑, ■ ❑ "' Control Panel equipped with Timer ETM/Counter---______ ❑ ❑ ❑ • n\ Pump Installed In El Bucket or E On Block or ❑ Otlrer ® ❑ r a' Pump Make/Model LIBERTY 290 I ®Floats or � Tank draw down 2 El Transducer �• in/min Pump capacity 44 a m S P 9uirt Height fi fl Pump on time 82 SEC Pump off time 4 HRS Deily Oow sat at 380 � '. 9Pd' I r uran.eavtrsme ) ( c+ Mason County OSS Installation Report pg. 2 Parcel it 222145000004 ABANDONMENTRECORD +I Were existing septic components abandoned as part of this project? ------------- - DyEa � NO If yes,please describe:DECOMMISION/FILLED PUMP TANK#7 REMOVED OTHERS Were all components pumped out and property abandoned per WA0246-272A.0300? •------ - 0 YES Nojt RECORD DRAWING ThI¢la a pnmemnl nand end...I be¢antl.and sl—Hpfl-enoupn 1..4-1.In qe,uea of..Ink--a.0 , n,ma Is—awtlopmmt Ty0a1 R¢md ' Olavfiigamnbin:plelnPeltlB menVaq gyenlaBan B lepul,9ep94mrplanN pveYon.NodM1 encw,resemdnNMldi eMelFpend p,quwtl bullgnp;WSMn alwllq xa1MFe¢, vnBa,aMsvaAonlwM,tlnwla,entldhe.m¢YN.al,ceaccu¢pWnl¢.Inmmpleb Rawld prelx'nAa meyceab edtlltlmYtleleya lnpml FeNM¢AoneppmMaMreleNtl palmiln. K Record Drawing Attached CERTIFICATION OF INSTALLATION ••. ' INSTALLER DESIGNER/ENGINEER I I certify that I Installed the system In accordance with I certify that the system has been Installed in actor- the septic design stamped APPROVED"by Meson dance with the septic design stamped"APPROVED"br County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been cleaved/approved by both the designer shown here have been cleared/apormad by both 't and Mason County Public Health and meet all State myself and Masp. CRunty Public Health and most all 'F and Mason County Codes. State and Mason County Codes I further certify that all Information contained on this I further coolly that all Information contained on this • i' th nd attached Drawing Is accurate, form and attached Record Drawing is accurate. a. It o4natum ofImitalljer I Oe Printed Name of Signae MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and s:A9Aeaa ^, ; Record Drawing on behalf of Meson County Public ' " F Health: >: signature olEm ronmantal Health Specialist Date (stamp,slgnai and date) , THISFORM MAYSESCANNEDANDAVAILABLE FOR PUBLIC VIEW ON THE MASON 001) YWEB SITE LbMbtl Bnlnald Z D S 00 ewe , � cAf� 0 Z m _ u ° omowoN au° 2 O1m = m �" m Z mZm0 F, B0 nnnm'3 ;"o C> mnm � ^[F D n m 6m;c,h�O N3 Nn � pp9.C1?^m'oj II �Ap 1n = y p m3G1 s,0 3 'm3o=mlk- � uNpc f O F 3yr�Z pj0 ° �0j3.(V.�lOS m'LA A 5A MOT,O o �.O J0 oomS.a3-�. DO�aGnS_ Z m Z F AaOm 0 'T £ sc Z � 0 vr O Zo 0 —10bMao 0 Z cm>m 009- R3am a 11 A 0 my ^ ° 4 a.,� N 0 K OcY m ono So ° FOo R °° °� 0� Q = D An g � -c naF O C vi 0 Z M. NSp HO _° a wZ Z Z O II nZ Vim '„- na � 5Ow Omm 0 O Z uf'� J �.o5 m O A 8 oa - � S rm0 a nao rmian "r� D m v yw Oo 'm 00ogZ f0Oyf[��-mAOAv. .3'"o. >Sno�•D�temo m-J�3. 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