HomeMy WebLinkAboutSWG2023-00504 - SWG As-Built - 1/30/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 1j Ot)$ !( Parcel# 'Za�03 O 31900 t/D
Applicant Name :52b 4c hetz y' umt,d nSubdivision (Name/Div/Block/Lot)
Applicant Address S3U 5L Aj,1 ";4 W
City, State, Zip dr.1>n>ny k* q-EyW Installer Name w
Site Address 49S- *4u 'A R.eQ Designer Name keyjj kkrl
INSTALLATION CHECKLIST
ull System Installation ❑Tank(s)Only ❑Dminfeld Only ❑Repair ❑Other
System Type A) S414 ow rypretreatment Type WU /4*is,1 'RwIt Coo
>5 ft.from foundation? --- ----- I2�'I(r�� ❑ NIA , YES ❑ NO
>50 ft.from wells7 ---------- -- `-"' �R� - - ❑ ❑
Z >50ft.fromsurfacewatel7 •------ J�y"rg �] _ ❑ FCl ❑
F Cleanout between building and tank? -- ❑ ❑
V Tank baffles present? --- -------- ❑
a24"access risers over each compartment Z ❑ ❑
W Effluent filter installed? - -- ❑
y ❑ i
N _H p L
Septic tank size „gel Manufacturer %NF,Irh �a c l
I
D-box water level and speed levelers used? ---------- ---- - NIA ❑YES ❑ NO
p0 Manifold/D-box accessible from surface?---- ------ --- -- - - ❑ ❑
NG
Check valves installed? ----------- - - --- ---- -- ---- ❑ ❑
2 Transport Line Size se�r k� fit! Schedule/Class Se h r(d
Bedrooms Installed(check one) ❑ 2 ❑3 ❑4 Urn ❑6 ❑Commercial/Other
>10ft.from foundation?----- ------- - ---- - - --- -- -- ❑ NIA YES ❑ NO
>100 ft.from wells?--- ----- - -- ------- ---- --- --- ❑ ❑
W >100 ft.from surface water?-- ------------- ---- - --- • ❑ ❑
u. >10ft.from potable water lines?---- ----------------- - ❑ ❑
Z >5ft,from property lines and easements?-- - ---- -- -- - ---- ❑ ❑
>30 ft. from downgmdient curtain/foundation drains?- ---- -- -- - ❑ ❑
0 Drainfeld level and observation ports present - -- -- ❑ 5d ❑
ZGraveless chambers or ❑ Clean gravel used? (check one)
Pro r cover installed over drainfeld?- ----- ------- -- - --- ❑ ❑
Pump tank setbacks consistent with septic tank?- ----------- - [I NIA ,LYES ❑ NO
Y Pump tank size_ _gal Manufacturer /NF, f t1 iyt
Q24"access riser(s)and accessible from surface?---- --------- ❑ ❑
yAlarm or Control Panel Installed? - ---- - --- - ---- ----- ❑ ❑
= Control Panel equipped with Timer/ETM/CCouurnntter-- - --- - -- - - ❑ (� ❑
ll Pump installed in [I Bucket or �On ETock or ❑ Other
Pump Make/Model d-I@,Yft•( �. YI'1 ,�. AFloats or ❑Transducer
Tank draw down of ue6min Pum ca acil r D. p p y �i7t apm Squirt Height � 1 ft
Pump on time Pump off time 1-{DUI[ Daily flow set at �0 pd
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Mason County OSS Installation Report pg. 2 Parcel# 9 6010
ABANDONMENTRECORD
Were existing septic components abandoned as pall of this project? -- -- ----------- ❑ YES ffi NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- ❑ YES NO
RECORD DRAWING ,
rnl¢le s p¢rmao.nr rocoN ana must h...corm¢ne aaec,lpuvo vouyb to.adoc.e.m h.ni of maim.....¢acmuie¢¢nd mlwo eeroloemmi. rroixal necwa '.
Oraw4g¢mnain'. erainneld 8 mar,il.la wanhlimi a pynuL Se ,Pumc'aoM l.¢dtlort N.rn arrow.receive NNnfb1.existirq pM proO.W'b0din3s,laalmn nl wais.weterAnes.
wsls..bserveli.np.M,d.nrouls.anJ OPerm.Lnm.¢nce eccecc.gn6. l+compkL e¢WrJ OrewYgs m.Ya.ate eCdlb,ulGelayc ln(net ltrsWldlim¢pprpval end reBletl parmiLL. '.
X Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I coRify 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 deviations
here have been cleared/approved by both the designer shown here have been clearad/approved 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 cartif at all tnforma contained on this I further certify that ail information contained on this
form and Chad Recor i gis accurate. form and attached Record Drawing is accurate.
Slg to of stoner Date ROy /I,
IDcdI rO As'S.
Printed Name of Signed 42:x� 9 y N
MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and ��9��, `safeT=?,�:'G�2�
Record Drawing on behalfof Mason County Public SSt ..
Health:
tt� ( I�IZ�— /za/Zs
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ormwa&P12'�"
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Septic Record Drawing a a�€o ' `ems TEAM HUGHES
Mann Cwn ,WA �nwah "c
AµIX t S.A.ress ENGINEERING
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N 3N-250-1555 snenon,wA sasea � da w ,1 " 40151041 Aro SW (253)2555458
Parma p. 224303190010 Olmm,WA W512 keNn�leamM1upl'aeang.com
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Septic Record Drawing TEAM HUGHES
Mason Cwnry,WA cn.arer: ; c .'� as
N N 4M.. ENGINEERING
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g 3W 2"151, 5384 3E AraEIa RC :F e�g^ p g Q���e
N 3W-258-I555 55elton,WA 86564 a 00151 WN Ave SW (353)3565C88
Parcel x: 328383t90p18 0l .pW.WA 98512 kmn@le ugMa nq.WM