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HomeMy WebLinkAboutSWG2024-00247 - SWG As-Built - 12/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY APPLICANT/PERMIT INFORMATIONmvil Permit Number SWG 7-.oZ.ti _ ou Lti l Parcel # itS14'Ciao ; Applicant Name C,,. fJ�u,. F arc. Subdivision (Name/DivBlock/Lot)ApplicantAddress 1-�ti(, �.lw R o., (to Stw.ecr,,,5r I ,r I City, State, Zip r1a„s, A IiId l Installer Name Site Address t 6 S..,e ogra� (,L, Designer Name AoA.,, 14, rV r- INSTALLATION CHECKLIST E5 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type 05�- eJ- Pretreatment Type k,, >5 ft. from foundation? ------- --- -- -- - ---- --- --- - - ❑ N/A ®YES NO >50 ft. from wells? - -- -- --- - -- -- -- --- ry {� rr��YsII� ❑ ❑ Z >50 ft, from surface wateR - - - - ----- - ---Cleanout between building and tank? - - ---- - Y 1 P024❑ IE ❑Tank baffles present? -- - - - - - - ---- - - - - - - ❑ © ❑24" access risers over each compartment?- -- -- -- -- - ❑NEffluent filter installed?- -- - -- - -- -- -- --- --� ❑ ❑ Septic tank capacity(working) Manufacturer 0 D-box water level and speed levelers used? -- - -- -- ® WA ❑YES ❑ NO �O Manifold/D-box accessible from surface?-- -- - -- - -- - -- -- - - ® ❑ ❑ IDZ Check valves installed? --- - - -- - - -- - ---- - ---- --- - - ❑ .® ❑ GQ 2 Transport Line Size ( Schedule/Class 40 Bedrooms installed (check one) ❑ 2 Q 3 ❑4 ❑ 5 ❑6 ❑Commemial/Other >10ft. from foundation?--- - --- - -- - - --- - --- - - --- - - El WA AYES NO C >100 ft. from wells?- - -- -- -- -- - --- --- --- - - ❑ ® ❑ W >100 ft. from surface water? -- -- - -- -- --- - --- -- -- --- - ❑ El ❑ LL >10ft. from potable water lines?-- ----- -- -- - - -- ❑ ® ❑ Q2 > 5ft.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) N�A Proper cover installed over drainfeld?---- - --- --- - --- ---- ❑ IQ ❑ Pump tank setbacks consistent with septic tank? ------ - - - - -- - ❑ WA ® YES ❑ NO Y Pump tank capacity (flood) Ita, at Manufacturer e Q24"access riser(s)and accessible from surface?- ---- ----- --- ❑ ® ❑ aAlarm or Control Panel Installed? - -- -- --- -- -- - -- --- -- - ❑ ® ❑ Control Panel equipped with TimerIETM/Counter- -- - - --- -- - ❑ fit] ❑ 7 d Pump installed in © Bucket or ❑ On Block or ❑ Other LL Pump Make/Model Aa w..„e.... .. artn , E9 Floats or ❑ Transducer 2 aTank draw down ns cw f_ in/min Pump capacity 3o apm Squirt Height N It, ft Pump on time xa ;E c. Pump off time -s .. Daily flow set at 360 gpd Vp]tlB]Y11/LOtB Mason County OSS Installation Report pg. 2 Parcel n 3 , -l 5e -c ', 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? --- - ---- ❑ V 1 YES NO RECORD DRAWING This Is s grmaMnt INoN and must Ed woodland and dada al aneuph to mlocam m the dead or mambmnw acgtldea and Nmre development Typloai aecom Dmddgs commn: oraMiea 6 mannow otememn s Igni aeplir/Wmp lank deatlon rvaN al reserve dramrield,existing and proposed Word,loralbn ptvrend welci wails.obaMvelim pads,tleaiMs,eM NIW IlYimenanta mods odors. ineanpkle rtmed Dmvnps may or ale additional deal In final instaltalon approval and rtlned delmds. ®-Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that I installed the system in accordance with 1 certify that the system has been installed in Ell 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 al attached Record Drawing is accurate. form and attached Record Draw' is accurate. r t 1✓s Signature or/n r µ� Date ;,s �tti 3s �: Printed Name of Signed zqy MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and �' soars lin�aTER ?' Record Drawing on behalf of Mason County Public t C!'n L'S I)n: ,NE'R"' Health: Signature of Environmental Health Specialist Der to (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY Al SITE updwiad eataote _mmm / [ ,_,__ ` § � . ) ( o � ( c o � _ § 2 2 ) | � � §