Loading...
HomeMy WebLinkAboutSWG2019-00430 - SWG As-Built - 3/20/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG WJ�IJ IParcel# ( 1 3Ur/�J Applicant Name 6\rz# 64A%t r✓ I Subdivision (Name/DivBIOck/Lot) Applicant Address H �TG7..�✓ City, State,Zip 6-,A ti .`//i Installer Name Ake Site AddressS Vf �L�" ICY Designer Name WM llS SSLI INSTALLATION CHECKLIST P Full System Installation ❑Tank(s)Only ❑ Drain1fi,eld Onl ❑Repair ❑Other System Type _}yMn1w"-- p'� :5 It A re tType >5 ft.from foundation? -______________ __ ❑WA ayes ❑ No >50 ft.from wells? ----- ------ -- v ,❑ ❑ Z. >50 ft.from surface water? ------ --- D -- - - ❑ 1 Cleanout between building and tank? ---- - Q - - -- ❑ O Tank baffles present? ------------- ❑ 6 24"access risers over each compartment?-- _ - ❑ ❑ Effluent filter Installed?-_____________ B _- Lu - -------- - ❑ ❑ Septic tank capacity(working) (Q(nO oal Manufacturer �n-Ct-14r A,— o D-box water level and speed levelers used? -- ------------ - [I YES ❑ � 0O . Manifold/D-box accessible from surface?---------------- - [x ❑ ❑ °7Z Check valves installed? --------------------- ----- ❑ 8�' ❑ Transport Line Size �'� Schedule/Clan `'0 Bedrooms installed (check one) ❑2 Rr3 ❑4 ❑5 ❑6 ❑Commerciel/Other -10 ft.from foundation?-- --------- - ------- ------- El WA YES ❑ No ❑. >100 ft.from wells?---- ----------- ------- ------- ❑ ,� ❑ W , >100 ft.from surface water?----------------- ------ - ❑ ® ❑ M >10 ft.from potable water lines?-- ------------------- - ❑ �] ❑ aZ >6 ft.from property lines and easements?---------------- ❑ R' >30 ft.from downgradtent curtain/foundation drains?---------- ❑ ❑ ❑ Drainfield level and observation ports present ----- ❑ ❑ ❑ Graveless chambers or [D Clean gravel used? (check one) Proper cover installed over drelnfield?------------------- ❑ ❑ Pump tank setbacks consistent with septic tank?------------ - ❑ µA [�I YES ❑ No '1 Pump tank capacity(flood)_"a at Manufacturer -Tn�i'I^`�' Z F24"accessdser(s)and accessible from surface?------------- ❑ © ❑ IL Alarm or Control Panel Installed? -------------------- - ❑ ® ❑ _. . Control Panel equipped with Timer/ETM/Counter--------- -- ❑ .0- ❑ a Pump Installed In R3 Bucket or ❑ On Block or ❑ Other "u Pump Make/Model -Z Ox ILW IS) [ Eloats or ❑Transducer a Tank draw down S n In/min Pump capacity opm Squirt Height G ! ft Pump on time ` 0 fuo-. A f Pump off time (I k ' Daily flow set at al7J gpd Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ------- 1� YES El NO If yes, please describe: 'f� Were all components pumped out and property abandoned per WAC246-272A-03007 ----- --- YES ❑ NO RECORD DRAWING This I......must rt=uN and must be aeeurme.nd d.adssues enough to reeman In Ise need or,m nnhn.nts seONao and wart dmadoymenk Tyqul Record Drearge wnlen: existed d manlfddodenlalbn&laywl,aeplklWmPlank Imalbn.NOM ease rear',emerald,a deers,aM proposed lobster.Melbn orwgl.walmAnes, we W.obarv,tbn pods,Nanwlb,aMONafinehlensnn a¢usyl b. Inwnpase flared Daminp may[lase standards do"In final InslelMtlmn appmk'al and adkd seems. ❑ 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 eccor- 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 hem have been cleared/approved by both and Mason County Public Health and meet all State myself end 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. G�So J14L 3-2a"26aSr Sign ure oflnstaller ' Date Printed Name of Slgnee 3ltef LS— MASONCOUNTYPUBLICHEALTH ` "} The undersigned approves this Installation Report and b3 22030834 Record Drawing on behalf of Mason County Public -.-Ll�—ry id isf a""'' Health: I�I Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTYWEB SITE Utudeaderapla >z e §§ )\ M> ! aM4 y * >!®os/ ;»q!N d __ _ 'S f ' / §zo]� c\ _ '` � w ��0@ \ ® !« r Gm! | O ; ;; ` Ic ` % 0 ¥ \` m t ■ f 0 - � §> m \ \ ! � � § ` (5 � M. $% � [ /; . _ ; G $ K , ® ) / >E �.¥ . \ ¥ § § f \ 2 § ee § ! > ° ` ( §{ _ § 2 ° � ^^ y ° m \ ' . { M o $ �