HomeMy WebLinkAboutSWG2024-00443 - SWG As-Built - 1/17/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG20Z'{-ayyJ Parcel# 32y Z&V-• 7,-• `Aosl
Applicant Name Alk&a 24 Subdivision (Name(Div/Block/Lot)
Applicant Address 5'' 7�[p 1
City, State, Zip .S{le. ' A IA Y J'S'° Installer Name 5&WA W J�i�
Site Address Saek,i Designer Name Tr"
INSTALLATION CHECKLIST
OFUII System Installation ❑Tenk(s)Only ❑ Drainfield Only [I Repair ❑ONte
System Type 5iU'�, �� Pretreatment Type If�_
>5 ft.from foundation? ------ - ---- -- - nnn El N/A N(YES ❑ NO
>50 ft.from wells? - --- ---- -- -- D - ❑ 5,w ❑
Z >50 ft,from surface water? - --- - -- _ ❑ ❑
FQ- Cleanout between building and tank? -- - BAN-- 6- A-- ❑ � ❑
V Tank baffles present? -- - - _ _ _ _ -__ - - - ❑ ❑
a24"access risers over each comparbnent? B _ _ ❑ '� ❑
W Effluent filter installed?. _-___ _ _ ___ y
Septic tank capacity(working) V 00 gal Manufacturer S
1j D-box water level and speed levelers used? -- - - - - -- - - - --- . WA ❑YES ❑ NO
O Manifold/D-box accessible from surface?-_ ____ ______ _ ___ . ❑ El
1 Check valves installed? - - -- - -- - - - - - -- ------ - --- -- ❑ O
Transport Line Size 2. Schedule/Class Lt0 4O
Bedrooms installed (check one) ❑ 2 bf3 ❑4 ❑ 5 ❑6 ❑CommerciayOther
>10ft.from foundation?- - --- --- ---- - -- -- - --- - -- -- ❑ NIA 2rYEe NO
G >100 ft.from wells?-- - -------- -- ------------- --- ❑ ❑
W >100 ft.from surface water? ----- -------------- --- - ❑ ❑
ILL >10ft.from potable water lines?--- ---- ---------- - ❑ ❑
>5 ft.from property lines and easements?-- - -- - -- - -- - ---. ❑
>30 ft.from downgradient curtain/foundation drains?- --- --_ -_. ❑ O ❑❑
Drainf eld level and observation ports present -- - -- --- - __ __. ❑ ❑
❑ Graveless chambers or Clean gravel used? (check one)
Proper cover installed over drainfield?- - -- - - -- -----------
Pump tank setbacks consistent with septic tank?- -----_ _____ . ❑ NIA ❑ YES ❑ No
bd Pump tank capacity(flood) )9 75 at Manufacturer 3P5
F 24"access riser(s)and accessible from surface?-- -- - -- -_ ___- ❑ ❑
a Alarm or Control Panel Installed? - ------- - ---- - ------ -
Control Panel equipped with Timer/ETM/Counter- -- ---- -- - - ❑ ❑
IL L Pump installed in ❑SSB��u� cket or On Block or ❑ Other
Pump Make/Model cjll-oM ` ICY L ❑ Floats or ❑ Transducer
O Tank draw down 2 In/min Pump capacity "14 opm Squirt Height (1 ft
Pump on time /m NI Pump off time '/mar Daily flow set at--?y gpd
UperoG ei21Rp18
Mason County OSS Installation Report pg. 2 Parcel#
!!! ABANDONMEN=2721ATI300?
Were existing septic component, abandoned as part of this projec ,(,(If yes, please describe; C�1 YEs ❑ NOWere all components pumped out and properly abandoned per WACYES
❑ NO
RECORD DRAWING
Tma Is a amlaMm rewM and moos be aecu2ro W dead",anou,b to'a""an In In,MN or ma„aMn.acuvttNt Ma find Ore Nd mnte r. DrainGNe a m.,eOd ananlaeon d Icyeut 5,n iix na Ind Iocendn Naeb eaaa ran
erre eminlxMn.eaisbnq and PromsM buiae re da bseafiyi W r TwdV weMli .
vrela, baerva opon pane,tleanwla,an0 m moina bor nence ecmae Mnt, mirnNe's WmNI»mwyermycreole nJdlpnaltlaepmIlnel NaallaiM epprwaleM/emae permib.
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❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI 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 Meson County Public Health and that any deviations
here have been clearediapproved by both the designer shown here have been clearedyapproved 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 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.
a 121z-7/-Ly
Signal of Installer Date
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Printed Name of Sign& ANDESIGWR
MASON COUNTY PUBLIC HEALTH51
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Heaffh: EAVINLS Wna
klleiw��( 1 k J l 7 f 1-Sr
Signature of EnNmnmerrtet Health Specialist Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE npfYtla/a+nme
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APPROVED
JAN 11 2025 APPROVED &-pep LS
MASON COUNTY ENVIRONMENTAL HEALTH NOV 19 2024
RET MASON COUNTY EhVRONVENTALHEALTH
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