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HomeMy WebLinkAboutSWG2022-00293 - SWG As-Built - 4/30/2025 MASON COUNTY PUBLIC H � Try Mason County OSS InstallationAPPLICANT/ PERMIT INFORMATION /1111 Permit Number VVG 2 G--2- z bdivesian (NameJDiv;Bioclv'Lat) C$ ��015 Applicant Name s �` `� - O Applicant Adcress 'n I,�.,!,?- T�- r�a++AI i — x �, scalier Nome o,oa City: State,Zip � f ;.�,,•. r M7 1- :�/�:" ?Designer Nattier. Site Address INSTALLATION CHECKLIST ❑O test 0 fj;tx:r `ank(Si Only t)rairt' id Only 0 Re Pair�;:il System Inst�ltatiaR 0 � pretreatment Type_ ._ - --- System type _!� EYES 0 NO - --- -- -- - ---- ❑NM >5 ft.from foundation'? _- -___- _ _- --- _ ❑ �, 0 >S{)ft.from�velt5? -- 0 0 >50 it.from surface water? - ❑ 0 z ❑ � Clc:artvat hetweert building and tank? - -- -- - -- - ❑ �. v Tank baffles present? ------ - ---- -- 0 0 d24"access risers over each compartment?•- - -- - ,❑, ❑ USeffluent filter installed?- 0 _ o-vr Septic tank capacity(working) t 25U___Slat . Manufacturer s4 [RNA ❑YES ❑ Np 0-box water level and speed leveters used? . - - -- -- --- - - 0 D 0 �O Mani{otdr►"3-box accessible from surface?- 4701W�- - Q e9,2 Check valves installed? 0.4 2 Iransport Line Size _al I 4 0 5 CI 6 0 Commer^;,iatrOtfter gQd^ooms installed(check one) 0 2 1-2-3 __ _ _------ -- ❑NIA ©-'ems 0 No >10 ft.fromfoundation? - -- - - ---- - ' _-- 0 (� 0 >100 tt from wrens? 0 WrL •>100 ft.from serfage water? - - 0 2 ❑ >10 ft.from potable water tines? 0 a 0 >5 ft.from property line s and easements?- 0El 0 >30 ft.from downgradient curtainlroundation drains - - 0 ❑ CIOrainfieM level and observation ports present --Q on e) 'Gravetess chambers or ❑ Clean grave%u. -'• (check - - -- ❑, 0 Proper cover installed over drarntleld 0 , 0 rF-> ❑ NO Pump tank setbacks Cl :CGststent With SQP'•fC rank? --A.---- - -- - -- NIA cr, >t4atwlactt�rar 1{a�t�..aa-.. Y Pump tank capacity(rfood! /Z,� --gal - - 0 Q 0 Z 0< 24"aCce?ss nserts}and ac:c:ess;ble from surface?-- --- - ---- - 0 i` Alarm or Control Panel Installed? • -- --- ---- - - E 0 a - 0 3 Control Panel equipped with Timer/ETM Counter d 0 On Block r 0 Other ____ __ - _ Pump installed in [„�'$uck©t or 1 ln:tts or 0 Trtnti,luu3r a- Pump MukcJh�acics L/bar/t:J om._�� c— J �F,m Squirt!lCIt7'1t- tt 0. ,__. -----• Tank draw down __.�_,rvr�in pump:-.a ty Pump on lime /• b._. rn Pump offe A Daily flow et at 14 0 { tun h sot i i Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD YES 2 NO 'Bee existing septic coMponunts abandoned as pan at this pre - - - - - - - - - f:yes.plC;�sc dsscribc:: _ 0 YES 2 No \Mop all componOitS pumped oul and prop--ertY abandoned pe-IN C24L•272A-03C40? ---- - - - RECORD DRAWING tia to lbw Mead ca matoten a..V+it.ea end tuba,dnvetnpraen!- f, 64 r'1e.:oge Tres to a patnta<na•.r record trtd wdoi be accurate and dRxrtptiva eaalgc to r, yr.�.,t�r s:,q a.,�car4t: to k--s'"'.e WON'>sarrvt 141. :YAW'V',.nr-1' i cued.NM S n;r+i4 a!rr>3:+4r b�1y- .t.;irp'.s rX""V "<1 ttr„7r>s N•• MC*rash: r, wti rdaibtl oa**'= �erft,v.r•ad.e.o ., oiwautl,we.t-.i <Mcrw.wa lLfed%With$ Inca.•r,a,t,x- . tkawir 7;'VWrto::v:Ar sictua rrstri a,final lceraiatk / fxL,.. "... I:4,6,-- , - .7-c--r.-, ------_____ .... .... . _..... , .score Drawing Attached CERTIFICATION OF INSTALLATION DESIGNER'ENGINEER INSTALLER • I certify that I installed the system in accordance with I certify that the system has been installed in accor- the septic Ceslgn starved APPROVED"by Mason dance with the septic design stamped-APPROVED"by County Public Health and that any deviations shown Mason County Public htealth end that any deviations here have been cleared/approved by both the designer shown ando have been Mason County redl l Pp atcd by both att and Maser. County Public Health and meet all State Sate and Mason County Codas Mason County Codes. I further certify that all information contaneo on this l further certify that all information contained on this form and a chcd Record Drawing is accurate. • form and attached Record Drawing is accurate. liAltti)4 Signature oh Installer /� W, bT L 6H3i I Pnntead dame of Srgrcc . C (Lt MASON COUNTY PUBLIC HEALTH �� The undersigned approves this lnstaiietion Report and i Record Drawing on behalf at Mason County Public J Heatt : Call (3 0 g;Prrnrt,rc of£nv+nxrmont7:H All Sddr.r31Mr Li.'rit> (Stamp,si+gnal:J r mire date) x+yarrr!rlt�l'.h THIS FORM MAY BE SCANNED ANt)AVAC.AB G LE-•R MAIM VIEW ON 1 1E MA5CAV COUNTY YrttB SITE t •.,2.<.-. * '''' -------A 1 '.. R E t il. :. • I‘-,i e.,1!.i.' - ` (b �^ Ci �u oy•i�, o :^ 4. aM q v JII o N 0 .. « W. + n o r m ti •n vAPPROVED � � adQ J 1 40v494 (:, ;•:.,:t, ; !, Zet4) APR 3 0 2025 1 +N a o Ca > 'ASON COUNTY ENVIRONMENTAL HEALTH Z Is` � °' RET d a "�'r., o4 r o •n M __ . is A k 1 i 4 0 = N° ° ", , O c�; W ••: � • .a . ,,, !d � O In 1 -. - �' L 3: •a " u �.4 J 2 V C 1; E '5 u m - \ i Q Ienb J \ \� \ 3 y W V Q I o 1 o b a v K �pe.e� j 1 V W m K J Y / \ C / ? ry M 4 . 11 '--.--- ;la. i fsi/ 0 • (DI •r, • z ila o s �. 4'' t . :st W 8 y V �`j KA1 » z, e • a, ti o 4a1 i I Ifl • J N 4- , Sa' issa :b., y O O I----�"� •_ F- )3 �� e( ,k I o¢sL a •