HomeMy WebLinkAboutswg2019-00176 - SWG As-Built - 3/22/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWGAtq- M171V Parcel # 2202W-77- m7,o
Applicant Name buN,b 21�R%tft. Subdivision (NamelDiv/Block/Lot)
Applicant Address t) SIL
City, State, Zip gu)hisn1,5w Q 'MI ' Installer Name
Site Address auh .5L 1�MIA'�I h Designer Name
INSTALLATION CHECKLIST
Wulf System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair Cl Other
System Type jhaVA0 Pretreatment Type
>5 ft.from foundation? -- - -- - --- - I fipq{f5 ❑NIA ❑YES ❑ NO
>50 ft. from wells? -------- ---- L[[u_VV-�C ❑ ❑ ❑
Y >50 ft.from surface water? FEB 1 t POPS ❑ ❑ ❑
H Cleanout between building and tank? --- ------- ----- - ❑ ❑ ❑
U Tank baffles present? -- -- ----- - ISy- -- - _- ___- ❑ ❑ ❑
a24"access risers over each compartme ❑ ❑ ❑
NEffluent filter installed?---------- ---------------- - ❑ ❑ El;1
Septic tank capacity(working) L1V gal Manufacturer /rem}
11 D-box water level and speed levelers used? ------------- - - ®NIA fives ❑ No
OR Manifold/D-box accessible from surface?-- ------- ------ - - ❑ 0 ❑
04 Check valves installed? ----- -- -- -- -- - - --- - -- -- --- ❑ IN ❑
F Transport Line Size Schedule/Class
Bedrooms installed(check one) ❑ 2 ❑3 ❑5 ❑6 ❑CommerciaVOther
,10ft.from foundation?-- ----- ---- - - -- ----- WA ®YES ❑ NO
in >100 ft.from wens?-- --- -- --- - - ® ❑
W >100 ft.from surface water?--- --- ❑
M >10 ft.from potable water lines?- - -- - �Iy fl__ p� ® ❑
ER
Q >5 ft.from property lines and easemenk- -- - 7I�h�"fF u ® ❑
> 30 ft.from downgrsdient curtaiNfoundlytY EN ❑ ® ❑
Drainfield level and observation ports present --- --=�--- --__- ❑ ® ❑
Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?---- - --- ---- ------- ❑ Q ❑
Pump tank setbacks consistent with septic tank?------------ - ® El NO
❑ NIP, YES
Y Pump tank capacity(good) 11 M at Manufacturer RR prerAd�
z
H24"access risers)and accessible from surface?-- --- -------- ❑ 50 ❑
1 Alarm or Control Panel Installed? ------ - ---- --------- - ❑
� Control Panel equipped with Timer/ETM/Counter---- --- --- - ❑ ® ❑
IL Pump installed in ❑ Bucket or ® On Block or ❑ Other
a Pum Floats or p Make/Model L'.6c,1r 240
`� ® ❑Transducer
d Tank draw down 2 a in/min Pump capacity 50 qpm Squirt Height—q4—ft
Pump on time I, 7y rn*,nr Pump off time L Daily flow set at %n gpd
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Mason County OSS Installation Report pg. 2 Parcel#
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-0300? ------ -- ❑ YES ❑ NO
RECORD DRAWING
This Is a parman[M record and must W accunta and doscrlowe enough to n.lwate In the need or maintenance¢wFles and luNn eenwpmene. Typia!Rewm
wings wnw n. onin3ea b man Pao otlenueon Is layout.Sell ipcmp lank wa:am Nonh a^ow reserve dranni ew.wsung and pmpaeo bakd ngs easi awd!a, moraines.
.vela.Momv,, wee.tlearouls.e-dc!her n'a.+reNMA a¢ess pane. Incempkr[Rewrc D'awing3 iNycreate eddieoNlde4p in fine!uunlYtwn apomn!aryl reb:eE pem.6.
APPROVED
FEB 2 5 2025
%IASON COUNTY ENVIRONMENTAL HEALTH
JBW
,Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 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 Slate 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 1 further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
77'a.�/
Sig ature of Installer Date Z - I •Z.S
Jr," Rote
Printed Name of Signee pSAW,d ems'"1'
yi, a e Y�r
MASON COUNTY PUBLIC HEALTH
�' S1W313 Jl.
The undersigned approves this Installation Report and dv' It Fy
Record Drawing on behalf of Mason County Public LICENSED DE51O1NEa
aIth: EXPRES: 03/22/-�,b
Sig t r vimnmenlal Health Specialist Data (stamp,signatures and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated W32015
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