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HomeMy WebLinkAboutSWG2021-00556 - SWG As-Built - 1/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SwG Parcel # U2M Al L{( _ [7xtD0 Applicant Name l.V1P. l ,fix Subdivision (Name/Div/Block(Lot) Applicant Address w Zip P,� � City, State, Zip r4i/Yln Installer Name WC1Y1 et/i suP Site Address _ Lit.), kCLO Designer Name J41 INSTALLATION CHECKLIST ❑ Full System Inds kation NTaMk(s)Only ❑Dralneeld only ❑Repair ❑Other System Type ly, .i Pretreatment Type 1p7 >5ft.from foundation? -------------- ------------- ❑WA OYES �` J >50ft.from wells? ------------------------------ ❑ ® ❑ _ >50ft.from surface water? ------------------------ ❑ O ❑ Cleanout between building and tank? .__________________ ❑ ❑ Tank baffles present? -- --- --- ------------- -----. ❑ ❑ ❑ 24"access risers over each compaNMn?--------------- - ❑ Q ❑ Effluent filter installed?-------- -------------------- n ❑ ❑ Septic tank size I.g-S-O gal ManufacYr f O Dbox water level and Speed levelers used? --- ----------- - ❑ NIA [aYES ❑ NO G0 Manifold/0.bax accessible from surface?--------------- - - ❑ ® ❑ Z Check valves installed? - ---- - - -- - - -- ---- --- -- - - -- ® ❑ ❑ i Transport Line Size—!A I? Schedule/Class 0 Bedrooms installed (chackone) ❑2 ❑3 34 ❑5 06 ❑CommemiallOkher >10ft.from foundation? - ---- -------------------- QN/A ❑ YES NO 0J >100 ft.from wells?--- ------------------------- - ❑ ❑ W >100 ft.from surface water?- ---------------------- - ® ❑ ❑ kzrL >10 ft.from potable water lima?--------------------- - ❑ ❑ ❑ >5 ft.from property lines and easements?--- ------------- © ❑ ❑ >30 ft.from downgradient curtain/foundation drains?- --------- m ❑ ❑ 0 Drainfield level and observation ports present - ---- Q ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainftekl?- -- --- - --- --------- [} ❑ ❑ Pump tank setbacks consistant with septic tank?---- -- ------ - NIA ❑ Yes ❑ NO = Pump tank size gal Manufacturer F24'access risers)and accessible from surface?-- -- - -------- ❑ ❑ ❑ a Alarm or Control Panel Installed? ------------------- -- ❑ ❑ ❑ Control Panel equipped with Timer/ETM l Counter------- --- ❑ ❑ ❑ a Pump Installed In ❑ Bucket or ❑ On Block ar ❑ Other LL Pump Make/Model.� ❑ Floats or ❑Transducer IL Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump oft time Daily Claw set at opd v,e.,M w-,waa Mason County OSS Installation Report pg. 2 Parcel a ABANDONMENT REGORD El eo� Were existlng septic components abandoned es�en of this project? F -- -'---'--' Y!E It yea,phase describe: nIA C rt''tG fa-.�k rd_ eyC 11 , i�s° C�ncr1}4 ,n :APkt: Were all components pumped out and ProPerlY abandoned per WAC246-277A-0300T -------- Yes, ❑ NO RECORD DRAWING ♦me I.a yermz71 rK d ana rues w--c -am a.erl"---sn b ttrbe•u m ma mea✓ImlMan.nea mvnled me tmun 4+Yepmam Mlnl RemN Nawinga[mlan Ormn4eltlAmanAolp menuYondbyWl.aMNWmp enk 1pVlbl4 No-N>'rvw,ruMw O�tlnMid erYNe eM pFp0iN 0uielnQe,bCdNM OI xeN.waYM1w, m:Is,ceaena4c�pa6.cleanrvtls anc oAee ma.ge anw¢vcpTYr IMApMM1 Retly4PMrya mry[rYle WYoiulcW}+In M1nel lneulYlian aGpeal uaWbE WnIb, See a �Crcl� ❑ 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 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 cleamd/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 Masdm 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. Signs btaller Oate PdntedN cis A MASON COUNTY PUBLIC HEALTH �O The undersigned approves this Installation q and Record Drawing on behalf of Meson County G Pubil o Health: rNryF ,1Q O SON*FN,, Signature of EnNronmental Fleaah Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW O THE MASON COUNTY WEB SITE uoee.e vemnme ansen — F O Flay 1 - APPRoveo JAN072025 MASON H.TI( I COUNIYEDJANMEMA� Cn "�1 t ��•s � � ` _Js• � • w �,/ne•(a. ![M.ad a/n••�s7.y�30�RLvr.Q, I