HomeMy WebLinkAboutSWG2024-00060 - SWG As-Built - 12/18/2024 Mason County OSS Installation MASON COUNTY PUBLIC HEALTH
APPLICANTI PERMIT INFORMATION
Parcel# il'
Permit Number swc o, 1i -ooci 66 r AL, Subdivision(Name/Div/Block/Lot)
Applicant Name 'r'ia�S N��'—d C'� { L
Applicant Address S160 i Ecso A/ RO• Fzr<x srcGauiT..
city, State, Zip ��< <'a"' wA 98Y851
Installer Name cuSZ2
Designer NameSite Address
Address '�---
INSTALLATION CHECKLIST
Dminfield Only ❑Repair ❑othar�_
Full System IrelaWlion ❑Tank(s)only ❑ ant Type
__-----
system Type MCA✓eT ❑NIA ❑ NO
>5 fl_from foundation? -________ ❑ 0. - ❑
>50 ft,from wells? ------------ _� `_ ❑ ❑
Z >50 ft,horn surface water? -______ __--________. ❑ & ❑
F Cleanoul between building and tank? -- By-
-��-r -- ❑ ❑i ❑
Tank baffles Present? .______ +y-y++r-� ❑� ❑
aU .____i ❑/ ❑
24°access dsers over each comps ]{
WN EflWent fitter installed?----- D � lt) IC t�
Septic tank capacity(working) Zoo �p'ga1her ^�
_-DEC - 1D21- WA LYT ' ❑ NO
O D-box water level and speed teveiers used _ / ❑
RO u Man'do1dlD-box accessible from surface?- - _-----
1❑9 ❑
m= Check valves installed? -_____pQ [ " SchedulelClass M 3o S`/
f Transport Line Size
2 ❑3 ❑4 ❑5 ❑6 ❑CommerciallOdter
Bedrooms installed(check one) ❑ � ❑ No
WA
>10fl.from foundation?---------------------------
_____________. 0 1y� ❑
>f(kl fl.trom walls?-_________ - ❑ L9'
0 >t00 fl.from surface water'- 11
� ❑
W table water lines?-____________________- ❑
LL >10 ft.trompo ❑
Z >Sfl.from Properly lines and easements?------"------� - � ❑ ❑
>30 ft.Horn downgradient wrtainffoundabon drains?-------_- - ❑ _/ ❑
G Drain level and observation Pods present -_used?
_- -_--
[pGmveless chambers or ❑ Clean gravel used? (check one) ❑ ❑ ❑
proper cover Installed over drainfield?----- � rEs ❑ No
A
pump tank setbacks consistent with sep0c tank?-----------
ca cily(floodJ oat ManufacWrer. ❑ ❑
Z pump _____
om surface?-______ ❑ ❑ ❑
Q 24°access dser(s)an -- --
f Alarm or Control Panel Installed? ------"- - ❑ ❑
6 with Timer/ETM er---- ----
f Control Panel equipped
D r ❑ On Block or ❑ Other
0• Pump installed in ❑ Bu Floats ar ❑Transducer
PUMP Ma el fl
Oom Squirt Heigh
� Tank draw down inlmin Pump caparaty gpd
d Pump off time Daily flow set at
Pump on time vpn.,eeavmte
Mason County OSS Installation Report pg. 2
Parcel# v/�J0.35r`/dG0 30
ABANDONMENT RECORD ❑ YEs ❑ ND
Ware ex5Nrr9 `+,P,,oempwos abaWmd ae pot elf the n✓ ---------------
il ym.P dam' __-- ❑tn:s ❑ No
Were at renb pNrgmd.1 and pWxly abardaoed Pre WAG246-Z/7A-03W�
RECORD DRAWING
1Ns s,m�'^`s4 v.rwor+snamW.sw�/wmvt pyn.NVP maa one.ems.�aaerr+i.on+mM.icnanm+a^�awmei-
..ezoo+�.avr^�eca�m.am.ru.ve•�u,a��a�m'W°eRm�a aeaga,+r
SeG /9� 0
[ ecoM Drawing Attachod
CERTiMAnON OF INSTALLATION
DESIGNER)ENGINEER
INSTALLER I cetbly that the system has been installed in accor-
1 cerNty that 1 installed the system in accordance with dance with the Wphc design stamped APPROVED°by
the septic design stamped`APPROVED'by Mason
County Public Health and that any deviations shown Mason County Pubic Health and that b wo ns
a raved by both the desigWr shown here have been ��ealth and meet all
here have been dearedf PP and Mason County
and Mason County publc Health and meet all State State�t and Mason County Codes
and Mason County Codes. I further erW that all informadon contained on this
1 hlrtler cerN/y that el mtgmatton contained on this
form and attached Recnnd Dewing is accurate.
torn an Drawing is acuurate. ,xyy
Sign o1 per
C �
Prnted Name of SQoee W
e Q28508 ?
MASON COUNTY PUBLIC HEALTH E®tgt
The undersigned aPProves this Installation Report and - SON
Record Drawing on behalf of Mason County Public �J
Health�:(//7
I\���1{ ' I afore arM data)
an+ p (stamp.sgr
signature a!Erwi/aame^t'I Ne'M'Sn°" iiw+�ynrA'a
THIS FORM MAY 6E SEMWD AND AVAIEAeEE FOR PUBIJC VIEW ON THE IAA.SON COUNTY VIER SRE
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