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HomeMy WebLinkAboutSWG2022-00366 - SWG As-Built - 2/24/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION rr�� Permit Number S;WG 2�Zy (`1(1`JluaU Parcel#_ 32v1IrL- (1- gooLDI Applicant Name p{�ek W('d Lhaa Subdivision (Name/Div/Block/Lot) Applicant Address 11 ,,� City, State, Zip Q Installer Name ,_)�W aM. Site Address 72Z nC�Designer Name Y'{OrAm A)rACY INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type ent Type >5 ft.from foundation? - - - -- - ----- U Vogujy4g NIA ®YES ❑ NO >50 ft. from wells? --- - - --- - ---- ❑ ® ❑ 2 >50 ft.from surface water? _FE821 Zry_ ❑ ,a„ ❑ a Cleanout between building and tank? -- l� V Tank baffles present? --- ---- -- -- By --- -- ❑ C24"access risers over each compartment?- - ----- - - -- --- - - ❑ ® ❑ rW Effluent filter installed?------ - --- -- - - -- --- - - -- - - - - ❑ ® ❑ Septic tank capacity(working) I IDO gal Manufacturer NI2 3Z� D-box water level and speed levelers used? - - - - --- - - --- -- - [2 NIA ❑rEs ❑ No OLL Manifold/0-box accessible from surface?----- - --- ------- - ❑ ® ❑ mz Check valves installed? -____ _ __ __ _ __ _ _ _ ❑OQ ❑ 2 Transport Line Size 21r Schedule/Class C1 O Bedrooms installed(check one) D@ 2 3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft.from foundation?------- -- _ __ _. ❑ WA ® vE5 ❑ NO >100 ft.from wells?--- -- -- - -_ _ �o__ ❑ 0 >100 ft.from surface water? --- - --- a >10 ft.from potablewaler lines?-- - ® ❑ w FF z a�j, , Q > 5 ft.from property lines and easements?-- 7p' __ © ❑ Q > 30 ft.from downgradient cartainlfoundation drairl� L;,.-_ _ -❑ ® ❑ Drainfield level and observation ports present -- --N°- -- '� k�w,_. ❑ ® ❑ ❑ Graveless chambers or CS Clean gravel used? (check one) y Proper cover installed over drainfeld?--__ ___ _ ___ _______- ❑ ® ❑ Pump tank setbacks consistent with septic tank? - -----______ . ❑ WA ® YES ❑ NO Y Pump lank capacity(flood) 1200 at Manufacturer Z NO f24"access nestle)and accessible from surface?-- --__ _ _ _ __ _. ❑ ® ❑ C Alarm or Control Panel Installed? ----- -- - ---- --- - ---- . ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter- - - - - - - -- - - ❑ ❑ 4. Pump installed in ❑ Bucket or 10 On Block or ❑ Other a Pum Tank draw down in/min Pump capacity p Make/Model 1;hrr}� 7R'p Floats or ❑ Transducer 2 a P . t4 ` 9Pm Squirt Height rJ f ft Pump on time I m;n Pump off time rl Our Daily flow set at LqO gpd U%en0d!1r•.0 Mason County OSS Installation Report pg. 2 Parcel s ABANDONMENTRECORD Were existing septic components abandoned as part of this project? ------ ----- - - -- YES ® NO If yes, please describe' Were all components pumped out and property abandoned per WAC246-272A.03007 -------- ❑ YES NO RECORD DRAWING TMa u a yaf111aNnr rcw.2.m...t ea aacurata and waulvta'.—.1.m mbc.p..M.,we al mainblunu aaWf.and NNn 0avabpm.M. Tp.R. D'a«,,c.nu�n Dnm6so a ran mid:.enwvdaaw-eS.s.c'o—v .usonq aM piowa.d cairn,..a ,.n M.e ft.. ..uea. aai4.ox.n,aan a=m wa.vm a v evu.n•...m.'+nca amw vm.u. incomm.:.,ewe D—t mar v. '.aft'..'dauy.m fi-k rmwe M4 ppgove ASOryCpUNT�ev�410� Jg �ENr4zy�ir ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I 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 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 cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet al/ 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 formand attached Record Drawing is accurate. form and attached Record Dmwin is accurate. SigSig at> sta0er Date JOL [half. Printed Name of Signee -`"� '"'"'• 2r MASON COUNTY PUBLIC HEALTH ss ti J P The undersigned approves this Installation Report and . ��Ho ADPM J.MUNTE0.- }- Reco wing on behalf of Mason County Public �.[,C['n9l+g rV'S' I4FR He h: z--2 S'gnt o Ea mental Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE °vda'ad varzo:d 00000 0 P T n I�11 T E S y Z 303. D m F z roE A T I 0 � I _ L _ 11g, m - x 0 r IHWY I >01 V d r N N O N N A z m 0 A a ° z A � C N $ Ll F N O O O A p A z F T Z A ~ A � o < n m x s � Z 'a fmA C Z o 'A m 4, H ti !y W ti Al vv a < � �� a o f G p y