HomeMy WebLinkAboutSWG2024-00450 - SWG As-Built - 12/26/2024 Mason County 033 Installation Report pg. 1
APPLICANT/ PERMIT INFORMATI ON MASON COUNTY PUBLIC HEALTH
Permit Number SWG - 'rcel#
Applicant Name � f
Subdivision (Name/Div/Block/Lot)
Appficant Address _ IiUR]k -"/E tNsr '<lir^
City.State.Zip \�(-\4j,,)f U{ Installer Name
Site Address bL--w1
Designer Name
INSTALLATION CHECKLIST
❑Full System Inetallewn P40(s)poly ❑Dwineeld ON, ❑Repeir ❑Otter
System Type Pretreatment Type
>5 ff.from foundation?
>50ft.from wells? ---- ---------------- ---- --- -- ❑WA yes Cl NO
2 >50ft.from surface"ter? ❑ ❑
FCleanout between building and tank? --- ---------------- ❑ ® ❑
U Tank baffles present? ._ __ __ _ _ ❑ ❑
a 24"access risers over each compartment?.__ ____________, Q r®st ❑
N Effluent fitter installed?-- _ _ ❑ ❑
_
SBPtIc tank size_\(� qal Manufacturer py li)II ❑
D-box water level and speed levelers used? . _ _---
❑WA ❑Yoe ❑ Ng
p2 McNfolrf/D-box accessible from surface?. _ ______ ❑ ❑- - ---------- ----
,= Check valves installed? ---- - --- - ----------- ❑ ❑
pQ ❑ ❑
i Transport Line Size -L:N?t t ScheduW/Clne tAO
Bedrooms installed(check one) ], 3. (31-,❑4 3
>10 ft.from foundation?___ ___ ____ ________.... ....❑B ❑DOmmerCial/O1her
>100 ft.from wells?----- -- -- - --------__________ ❑ WA ❑YES ❑ NO
>too a.from surlew weer?---- -________-- __ ❑ ❑ ❑
>10 ft f M Potable water lines?---__ _____________ ❑ ❑ ❑
> 5 ft tom Property lines and easements?---_____- _ ❑
>30 ft.from downgraolent curtain/foundation online?-- - _. ❑ ❑ ❑
Drainfield level and observation ports present ---_ ___ ___. ❑ O ❑
❑ Greveless chambers or ❑ Clean gravel used? (check one) ❑
Proper cover installed over dralntekt? ❑ ❑
Pump.tank setbacks consistent with Septic tank?---_________ ❑
0 61 raA YES ❑ NO
X Pump lank size
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at
24"amass mare,and accessible from surface?--__________. ❑
R Alarm or Control Panel installed? - - - - -- -- - ------------ ❑
Control Panel equipped with Timer/ETM/Counter- - - -______. ❑ ® ❑
a ❑
Pump installed in 14 Bucket or ❑ On Blcck or ❑ Other
Pump Make/Model ened:2 ��
164LYedts or ❑ Transducer
6 Tank draw down_L j! .-PumpcaPaciN m
/�� �— �P Squirt Haight—(.7 _ff
PUMP on time s$G pump olf lime Daily flow set at
pd
uwswen�rrors
Mason County OSS Installation Report pg. 2 Parcel a
ABANDONMENTRECORD
Were existing septic CD,c0nems abandoned as pan Ot this r 9 .-_ _ _ _ __
p olact __ __ M ❑11 yes, please describe. \v=s NO
Were all components pumped out and properly abacdoned per WAC24e-272A-03007 - - -- -- -. �{�-11��0 ❑ NO
RECORD DRAWING
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❑ Recortl Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 certify that 1 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 Me septic design stamped"APPROVED"by
County Public Health and that any deviations shown Meson County Public Health and that any deviations
here have been cleared/eppm ved by both the designer shown here have been clemMWeppmved by both
and Mason County Public Health and meal all State myself and Mason County Public Health and meet ell
and Mason County Codes, State and Mason County Codes
jfut�th certiy Mat all information contained on this 1 further certify that aN information contemaid on this
a,dsmi,,
cord wing is accurate. form and attached Record Drawing is accmete.
Signature1 ZA Date
er��n_I Cer�`G
.rnreb mane m s�gnee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this installation Report end
Record Drawing on behalf of Mason County Public
Health
_mow 1
99neture of kovicoorinjohn Health Speclelbf 0.1.
(stamp, signature and data)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE va..lwemrmr.
10871 NE Noth Shore RD septic setup info
Draw down 1"=22 gallons per minute
Squirt height 5'
On time 1 min 22 sec
Off time 3 hr
30 gallon dose
240 per day
Timer 0:43:06
Cycle counter 25
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AS BUILT
APPROVED
DEC 2 6 2024
MASON COUNTY ENVIRONMENTAL HEALTH
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