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HomeMy WebLinkAboutSWG2023-00202 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PU IC HEAL H ! HrrLIV.bu i l rcr ms 1 ii rVrurims surf r G 1` I Permit Number an �' 00 2.° parcel# 3 a,Z, �l 8Q I �® ��� J a SWG vM+ ^ It' �O il DDiicani Name �am �O\'f\ Subdivision ( arise/uiVii3iocivi-ot) c�.i Applicant Ad tress 1 5 .37 1•S US W tlm`tAp„i I I City, State, Zip 5 t L L.S°� 9 8 0 7 Installer Name (. 2.d — sk 1 Site Address '7 0 a E.Ar i Designer Name ea cc ky R:p�C•,r. I INSTALLATION CHECKLIST I I1 Full System Installation 0 Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other i system Tyne Pressure Trench pretre2tman►Typ. NuWater i i '5 ft. from foundation! - - i i NIA S YES i i NO i I >50 ft.from wells? - nN ElI 1 2 -5u ii.. from surface water% - - u N) u i "J u i I V- Tank baffles present? - - ❑ N 0 I i `A.. -nr.ne•e• r:Sor�o`lor.each compartment'? - I I Niu I d r" U 111 W Fffli sent filter inctaller17- t—t N n i 0 u u I Septic tank size S Z.0 0 dal Manufacturer 5 01A Y A 104.V ACit I i i ICID-box water level and speed levelers used? - - ❑ N/A ElYES ❑ NO I �J I tm'O rvianifniriii t-any arrpccinits from ci iriara7- u Si u i 5 Check valves installed? - n n n I I r�iR I 2 Transport Line Size 2." �O Schedule/Class i i I Bedrooms installed (check one) ❑ 2 N 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other i ›10 rl from Gpinrialinn7 i i NiA � VFS i -i Ni) I >100 ft. from wells?- N ❑ I I 1- 1 ^ f J i ICr; >100 tt. trom surtace water? - - Lf NI U I L:i. -•iu ii. huts: puiabie wait:: fines?- j ;^ i IZ > 5 ft. from property lines and easements?- - ❑ m ❑ I i -- - nn4 I._ _ .1-.. _ ,r_ J_.•__ A •__n r� r, r--i I I Y. > Jv IL. it Oil'uuMigi avid IL trUi wall a taut luotiuli uiatiiS_ - _ - - J -- - - u tJ rirYmfinlri In..01 .nrf ni.cnn_onfinn nn►h-nrnnnnf i—i i-'-i i i IIN Graveless chambers or ❑ Clean gravel used? (check one) i Prnnar rnvar inctaiiari nvar rirainfiafri7. t—i 1 i i t i i Psirnll lank timiilark:r:imeiciani_wiiil vr_I►iir iarlk?- I i N1�1 kJ iN vEc i i `!o I r_ `w t ,`1� I P :mr,tank s:... 1 Z I :nl �A..r...fnr.f..rn� ��M �\c�c.MLJ�1J VV i IQ 24"access riser(s)and accessible from surface?- - ❑ ❑ El tt_ i • diem!or i-rrltrei Gonni 1netotled? - i-1 I i y r i I IO. u I 2 Control Panel equipped with Timer/ETM /Counter- - I,_,l N n I I a- Pump installed in ❑ Bucket or On Block or ❑ Other I IM Pump Make/Model 6•�1d I) S� m N Floats or ❑ Transducer i i lank rims.:,do::m I • J nim.n pump rc p c y 2�p.�2. gpm tiqu:r1 Hc:y1 t �- tt i I 1 ru: :p:,.. fits= 1• T rvl l !y rt::::r tirrY:...... Li 4-12-) �a::), ur: ..�i at 3`0 Lirs i r Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# i - w w sr�i►arwae-ra�•r r•i+�.�rr. . . i I ABANDONMENT RECORD i v-vee rxr,iu)u Zit:pil- (.t)flluufleuts abandoned as pad ui lilts UiUteta•i - i 1 YES S iio i IIf yes, please describe: I j vvere all components pumped out and property abandoned per WAt;14b-1/2A-UJUU! - - D YES U .. I I RECORD DRAWING I This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. typical Record i i Drawings contain i)rainfield 8 manifold orientation 8 lavotlt Senticlotrmo tank k,ahon North arrow reserve drarnfield enslino and oroposed buildings location of wells waterlines i i Iweria,umervautxr pOrn.Uvarrwu,MIK)curer Irlanrtertdrrt.0 dulaa pthrrta. munnplere Reuxu Jfdwrrrge may txedle dou.Uulydr uetaya in intdr rnwsauul dpprw+n Will relate()WHIM. I I I I I i i I I i i I I I I I I I I I I x❑ Record Drawing Attached I r`COTICI('ATlrtkl r1C IAICTAI I ATInAl i _ ... .,� ..�. - .. 1 INRTAI 1 FR I fFSl( PJFR/FN(;INFFR I i __ i - __ i I /certify that I installed the system in accordance with I I certify that the system has been installed in accor- I i tilt. 5Yt1i;ii:iir...utrt Stil))f)kri "AYi-rRCiVi-i. by Mason i fiai)f:e with 1111a Mllt design sth,u,)rul'AYP OVI-I) by i ICounty Public Health and that any deviations shown I Mason County Public Health and that any deviations I 1 I IV/e IIdVe UCCfl tdtidfCU/dppIUVCU uy Uutll WC ue.s/yr tut JIi11w11!WIC IIdVC beet',&,l leU/dpp,UVCU U)'UVlll I and AAacnn Cnsrnhr Pllhlir I-health and moot all c'fafA I n mucolf ad AAacnn Cr-Isl.-Ili/ Pithlir oallh and mot all i r - i Iand Mason County Codes. I State and Mason County Codes i i further certify that ail information contained on this i i further certify that ail information contained on this i Iform and attached Record Drawing is accurate. I form and attached Record Drawing is accurate. I i i i I, ._.C::;--12.1 . .. . s\cA2.5 I J;y IlJtd O lldtUl&VI l!CI dle 1 1�0.. Zch�e.-- I I .. Printed Namc of Signcc I P. I i i (,4�:of Ls,do AiMASON COUNTY PUBLIC HEALTH I ���,•y,��F' ,T I 1 1 he undersigned approves this Installation Keport and � !�4 -`.�r��� I n__...:.. behalf of r+_ ..,n..Lr_ r' Bee.:).J.R '- r ": �t' I; ?ecor d Drawing t,,^i behalf of fvla,Vil COUri y r ULJrn i cri`•• M r ,t.7-: i I Health: I `a" t.—u i � � �2�i s z�zs i i r ; ISiyrraiule ui cfIVttUnrrrt:niii nt;uiiit Spucidiroi r✓dic I (stamp, signature and date) IIMMMj"9"2 3 Ti ii,.)r-GZrvr mr:,L.,. ,.) 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