HomeMy WebLinkAboutSWG2024-00413 - SWG As-Built - 4/15/2025 Masan County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number �'.':G �2,�- � Parcel # CL 22 d L(- -Our
Applicant Name A3G,1y\. I(\}tr Subdivision (Name'Div Block Lot)
Applicant Address 2.201 G3r f ie,
t
City. State. Zip NA9lCkt gait. Installer Name 146W .
Site Address N AT yveyt_ 0k Designer Name A6o...rh t{t)0-kr
INSTALLATION CHECKLIST
1AFuii System Instaila:.on ❑Tankis):Only 0 Drainfield Only ❑ Repair ❑Other
System Type OCc,savC�, Pretreatment Type
>5 ft.from foundation? ❑ NtA MYES 0 NO
>50 ft. from wells? - rtg-��- Elail IDZ >50 ft. from surface water? - 5 ❑ 71 ❑
HCieanout between building and tank? - - AN_1_a 20.5- - - ❑ in
U Tank baffles present? - - - - ❑ 71 0
a24" access risers over each compartmen . Y - - - - ❑ 0
W Effluent filter installed?- - ❑ 0
N
Septic tank capacity (working) I\c1] oaf Manufacturer_ \A pfe }-
. .0 D-box water level and speed levelers usec? - - D5N'A 0 YES 0 NO
p0 Manifold/D-box accessible frcrn surface?- - 14 ❑ ❑
m- Check valves installed? - - L� 0 0
GQ I.
2 Transport Line Size 1 i ZS Schedule Class set, 40
Bedrooms installed (check one "2 0 3 ❑4 0 5 ❑b ❑Commercial Other
>10 ft. from foundation?- - ❑ NA iSpYES ❑ NO
CI >100 ft. from wells?- - 0 0
W >100 ft. from surface water? - - 0 ❑
t�., >10 ft.from potable water lines?- - 0 ❑
Z > 5 ft. from property lines and easements?- - 0 0
d
IY > 30 ft.from downgradient curtain/foundation drains? - - 0 0
0
Drainfield level and observation ports present - . ❑ 0
0 Graveiess chambers or (Clean crave! used? (check one;.
Proper cover installed over drainfield?- - 0 NO 0
Pump tank setbacks consistent with septic tank? - - 0 NIA ZIl YES 0 NO
Pump tank capacity (flood) ` - gal Manufacturer LA a ce.CG,a}-
et24- access rise and accessible from surface? - - 0 110 ❑
.a Alarm or Control Panel Installer? - - ❑ ❑
O.
2 Control Panel equipped with Timer i ETM/Counter- - ❑ 0
e- Pump installed in ❑ Bucket or li...tOn Block or ❑ Other
1- Pump Make/Model C AQ N O S \ [Floats or 0 Transducer
Ia Tank draw down 0;Z'i^ in.,min Pump capacity gc-- Scuirt Height ? b-De.? " ft
Pump on time 16 nnitiAe.e Pump off time Z },ours Daily flow set a: 2 N,d gpd
Jimmmmmi
Mason County OSS Installation Report pg. 2 Parcel
ABANDONMENT RECORD '
Were existing septic components abandoned as part of this project? • - ❑ YES NO
If yes. please describe:
Were all components pumped out and properly abandoned per WAC246-272A-03oo2 - - 0 YES ❑ NO
RECORD DRAWING
This is a permanent record and nwst be accurate and descriptive enough to relocate in the need of maintenance activities and future development. Tyre P.
:-awings costa-n Drar^ e!c& rar:4,3C orieraton&a,-o,.: Seo:cpurr.p rang!Cca:4.n.%;,-r.a ca reserve ara of ec exrstng and propose4 buiC rags ca:on or wells.wa:er.res
..a s :-se-+anon por's deancuta a-C ether rra ntenarce access poets. Innppn•,pi:e Record D-awrngs Tar create ax Nona!ae!ays:r rra'•:s:ananon approve an rea:eo pe—s
I
0 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 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
sere 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 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.
19'641/ g/I S I z 5
S,g fature of Installer Date A9-----
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Printed Name c`Sionee or, ' vet
/��:,/ticj•nY w.,„ '.iy
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MASON COUNTY PUBLIC HEALTH i+,i, •�•;.\
or
The undersigned approves this Installation Report and r(v ��,�A
Pecord Drawing on behalf of Mason County Public 07
. ADAM JuHUNTER '"*'
Health. n _` .t'•t . nist'b'tSE'^;(;y ;r�...
S:gneture of Envir rnenta!Health Specialist Gate
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR=irBLIC VIE';:ON THE MASON COUNTY 11E6 SITE UPdebd&2t'20ta ,
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