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HomeMy WebLinkAboutSWG2023-00482 - SWG As-Built - 12/18/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANTI PERMIT INFORMATION ��r�l.�Q�2- Parcel# - �� Permit Number SW� 7 7 - , � Subdivision (Name/Div/Block/Lot) Applicant Name CO�nTYI P Applicant Address OA x�X �03, — c ,_,,�o mart p.S G wp; Cl$5"' j Installer Name �a City, State, Zip G l(Yl rG t.1 th�f 0. Y,QSjDslgner Name Site Address �— INSTALLATION CHECKLIST ❑ Full System Installation Tank(s)Only ❑Drainileld Only Pret�Repair El tment Typo Other System Type ❑ IA ___ __ _ _ I�>JYES El NO N >5 ft.from foundation? - - ------ ' -'- ` _ _ _ _- � ❑ >SO ft.from wells? .__ _ ____ _ _ ____ _ _ ____ _ _ _ ____ _ ❑❑ ❑ Y >50ft.from surface water? - -- - -- - - - - -- - -- - �' ❑ Z ? -__ _ ____ _ _ ____ _ ___ - ❑ FCleanout between building and tank. 11 ❑ O Tank baffles present? -- -- - - - - - - --- - -- - ❑ a 24"access risers over each compartment?-___ - -_- - - --- - 11 --- ❑ Er ❑ y Effluent filter installed?- - -- Septic tank capacity(working) I04 gal Manufacturer t-CZko-ker- ❑ NIA ❑Yes — O D-box water level and speed levelers used? ----- - - ---- --- ❑ ❑ O No J CLL ManifoldlD-box accessible from surface?- - -____'_ Cl ❑ 1 Check valves installed? - - -- - - paZ Schedule/Class-��- S Transport Line Size�--- 2 ❑3 ❑4 ❑ 5 ❑B ❑CommerciallOther Bedrooms installed (check one) ❑ YES _ _ __ _ _ _ _ _ _ _ __ _ _ _ -- NIA ❑ ❑ No ❑>10 ft.from foundation?- - - - -- - ' ❑ ❑ G >100 ft.from wells?-- - ❑ ❑ ❑ i >100 ft.from surface water? ---- - - --- ' ❑ ❑ LL >10 ft.from potable water lines?- ---- - - - - --- - --- - ❑ ❑ ❑ " Za > 5ft.from property lines and easements?- - - - - - - - -- - ❑ ❑ R' >30 ft.from downgradient curtainlfoundation drains?- - - -- - - - -- O ❑ ❑ Drainfield level and observation ports present - - - - - - - --- - - -- ❑ Graveless chambers or ❑ Clean gravel used? (check one) ❑ ❑ ❑ Proper cover installed over dminfield?---- ---' ❑ NIA YES El No Pump tank setbacks consistent with Septic tank? - ---- - - --'"- - ❑ Z Pump tank capacity(flood) gal Manufacturer ❑ ❑ ❑ G 24"access dser(s)and accessible from surface?- - -- - ---- _- -____ _ ❑ ❑ ❑ ~ Alarm or Control Panel Installed? - - - --— - - ❑ ❑ ❑ a 'F Control Panel equipped with Timer I ETM I Counter. . ... . . . ... a Pump installed in ❑ Bucket or ❑ On Block or Other ❑ Floats or ❑Transducer Pump MakelModel m Squirt Height ft Tank draw down inlmin Pump capacity i1P C. Daily flow set at oPd Pump on dme Pump oft lime U�.dmlame Mason County OSS Installation Report pg. 2 Parcel ii ABANDONMENT RECORD _ _ _ _ _ . �VES � NO Were existing septic components abandoned as part of this project? - - - - - - - " - It yes, please describe: vas NO Were all components pumped out and property abandoned per WAC246-272A-0300? - - - '-- RECORD DRAWING m yR aa.y a n,amyY,un<.ectivinn and wwr.an.wommL rypmai Ra=o,e Tnh r a amrn.M na«a add m.at,a au.nda and&aartgw• unxswmunnre Na�raa^^'".reae^'a aainn.Id ..isms olio w.wa=d wido'. Inuern m woos.wmem.1 ,a.,,mnwin. Dt.i Id&mantldd.,cenlaYon&IeywL Sao�w lnmmpbb Reawd Dnwin9a—Y meatoaWaxna''dalal In finermsraNOor approval antl rew,otl pa'mns. walla,aMervatim'paft.cbarFNs,antlo,ar nlaaadnam att WI 5k.P h«rk S Q.+ {OLe i/Y PSI-{av^�o "VZ4 t� f�we {d e.a.hJar ©Vu hea&1 J i CJ/ Q}{mat. Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNERI ENGINEER INSTALLER 1 certifythat the system has been installed in accor- 1 certify that I installed the system in accordance with APPROVED"by dance with the septic design stamped" the septic design stamped"APPROVED"by Mason Mason County Public Health and that any deviations County Public Health and that any deviations shownhave been here have been cleared(approved by both the designer myself shown and Mason County Pu hem b cpHealthd b and meet all and Mason County Public Health and meet all State State and Mason County Codes and Mason 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. 17-74 l Date Signature of Installer ?lies — printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this installation Report and Record Drawing on behalf of Mason County Public Health: I�I`��,L� � � (stamp, signature and date) Sgnatum of Environmental Heaan Specialist D^^ eouNTr wee SITE "°ai1i0bR1nm' THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON v w 1 11aa � + - ` lot