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HomeMy WebLinkAboutSWG2023-00410 - SWG As-Built - 1/21/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 7 d a3 -G`o4ir) Parcel#_ Applicant Name &or( Ti Dj#&Si Subdivision(NamelDiv/BloridLot) Applicant Address 9.t1 Box a1755, SrJSE,FX_V4��r'In-�Q City, State,Zip An_/lv' h- cJA, ! .�,� Installer Name /� . & -ro Site Address la/7 N£ .21-w!a>, =� n-P Designer Name 3':w1E� INSTALLATION CHECKLIST ❑ FuH System Installation MTank(s)Only ❑Drainfield Only WRePair ❑Other System Type Pretreatment Type >5ft.from foundation? ---------------------------- ❑wA [Eves ❑ No >50ft.from wells? -- --- ------ ----------------- - ❑ ® ❑ Y >50ft.from surface water? -__ __ ___________________ ❑ [E El 0- Cleanout between building and tank? ------------------ - ❑ ® ❑ O Tank baffles present? -_ __ _______ _ _ ______________ ❑ s❑ ❑ a 24"access risers over each compartment?---------------- ❑ 12 ❑ HEffluent filter installed?---------- ---------------- - ❑ ® ❑ Septic tank size Nq al Manufacturer Na.J l^rx e.,A(- o D-box water level and speed levelers used? --------r------ ❑ NIA ,®YES ❑ NO p0 Manifold/D-box accessible from surface?---------------- . ❑ ® ❑ GQ Check valves installed? --------------------------- ® ❑ ❑ f Transport Line Size cf '� Schedule/Class JO iN Bedrooms installed (check one) ❑2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?--- ----------------------.- ❑ WA [Eyes NO G >t00ft.from wells?-- --- ------------------------ ❑ ® ❑ W >100 ft.from surface water? ------------------------ ❑ ❑ LL >10 ft.from potable water lines?---------------------- ❑ 19 ❑ aaz >5ft.from property lines and easements?--------------- - ❑ 09 ❑ K >30ft.from downgradient curtain/foundation drains?---------- ❑ ® ❑ Drainfield level and observation ports present ----- ❑ ❑ Graveless chambers or S1 Clean gravel used? (check one) '. Proper cover installed over drainfield?------------------ - ❑ ® ❑ Pump tank setbacks consistant with septic tank?------------- ❑ WA ❑ YES ❑ No Y Pump tank size am v al Manufacture 24"access r(s)and accessible from surface?---- --____ - ❑ ❑ ❑ 6 Alarm or Control stalled? - ------- ----------- ❑ ❑ ❑ Control Panel equipped with Time ter----------- ❑ ❑ ❑ tL Pump installed in ❑ Buc r ❑ On Block or ❑ Other Pump Make/Mod ❑ Floats IN ❑Transducer IL Tank draw own inimin Pump capacity anm Squirt Height ft Pump on lime Pump off time Daily flow set at gpd Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD mm Were existing septic components abandoned as pan of this project? ------- -- ----- - ❑ YEe QI NO If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? ------'- ❑ YES ❑ NO RECORD DRAWING •.Trna I .permawm 1¢Cpre ane mmr he eC 7-ana triNlve enov,h m r ocaw In u,.nx!er nwlmenenp.oM{Na..M(YIUm Aav9bpillanc troiG itefAra eraMngs wn�ain'. ereNfAM fl menNdJ dlendrpn 6leyoul,eaWltlpunW rank/cation,NOM ertax,rewras erainrMd,a 1.,and pmWsed Du.,w,loratinn al wall&weleMnas, wNls.pbcarvalUn ppns,neerouu,em peer malnrenance.ecmapdnla. Irca op W de np mev vea@add2onN dNo In final insmlWW approval and f a Pe b S6E ATrAe— ed pra l+ Jg ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with I 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 deviationhere 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 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 forma d att di Drawing is.1cpr�te. form and attached Re Drawing is accurate. 7-0 xs— Y: '9 signature ofinstaller Date ? , Printed Name (Signs NtW MASON COUNTY PUBLIC HEALTH "♦Nraoavo iC N tib 5'i Nt'0. The undersigned approves this Installation Report and e-x :10 $-.Ld} Record Drawing on behalf of Mason County Public Health: Sgnerum ofEn�He &SPM811iSI Oale (stamp, Signature andd910) -'a FORM MAYSESCANNEDANDAVAIL48LEFORPUBLIC VIEWON JHE MASOIVCO(lN1VWEgSITE *leo'&71/lpte BLD2023-01080 5.• Nx+1� s'mR RJsre✓ ; a - en h+w+ �,-. P 5r SC ALF 1 / 'NTH YOWE D MIERO APPROVED r JAN 2 1 2025 ' MASON COUNTY EN'v1RONYENT4L HEAL% RET l' e �i i�