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HomeMy WebLinkAboutSWG2021-00200 - SWG As-Built - 7/16/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG Z O Z i- 00 ZOO Parcel # q Z 00 t3 176 9 0o? 4 Applicant Name a...,Nt Cf(Y .Put--ToA.4 Subdivision (Name/Div/Block/Lot) Applicant Address I6-4-‘ LA-yL A- S7 k City, State, Zip C'ec,mY (2/ A `1 ro Installer Name s,n A L_ (-& o2 VS L -I-- Site Address go u.). Ip1\eRoocoS /x. Designer Name C.At)tLt iftrYI P rem G4-4,Pc INSTALLATION CHECKLIST (g,Full System Installation ❑//Tank(s)Only 0 Drainfield Only 0 Repair ❑Other System Type t is U'•cGR E,c0 `'�` "w Pretreatment Type Al/A >5 ft.from foundation? - � - - ❑ N/A ® YES ❑ NO >50 ft.from wells? - A +\ - ® ® 0 Y >50 ft. from surface water? - ® 0 HCleanout between building and tan i -c - - 0 ® ❑ U Tank baffles present? - v- _�7 - - - - -- ❑ l21 ❑ C~. 24" access risers over each compart ••• - - -- ❑ N 0 `W Effluent filter installed?- ` - - - - - El GI ❑ Septic tank capacity(working) \ZC' gal Manufacturer -d Vc,►'cc-fine^T S'rvrc(rS 0 D-box water level and speed levelers used? - - ist N/A ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - Gil 0 u. 00 Z Check valves installed? - - N ❑ ❑ OQ E Transport Line Size Schedule/Class Bedrooms installed (check one) 0 2 ❑3 (g1 4 0 5 ❑6 0 Commercial/Other >10 ft. from foundation?- ❑ N/A 12 YES ❑ NO >100 ft.from wells?- - rg ® ❑ o W >100 ft. from surface water? - - ® El El u. >10 ft. from potable water lines?- - ❑ I:. ❑ Z >5 ft.from property lines and easements?- - El ® Elid >30 ft. from downgradient curtain/foundation drains?- - ❑ ® ❑ o Drainfield'level and observation ports present - ❑ N 0 ig Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 51 ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A Ca YES ❑ NO • Pump tank capacity(flood) • I'V gal Manufacturer 'k,M.19 R•ACc,7)PnT 191,ices <• 24"access riser(s)and accessible from surface?- - 0 ® 0 a Alarm or Control Panel Installed? - - ❑ tii ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ f1t ❑ d Pump installed in 0 Bucket or Fa On Block or 0 Other a. Pump Make/Model Li hert--12 2 q0 ?/Y he ElFloats or 0 Transducer rr a Tank draw down ? in/min Pump capacity -/- gpm Squirt Height 6'Q :1 Pump on time 1,S w.ti. Pump off time 1-14 k Daily flow set at `t t>D qpd u9ua ealrzOI8 Mason County OSS Installation Report pg. 2 Parcel # y ZOO 87g9 ( •r?9- ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES Ej NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES Ej NO RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to re-locate In tha need of maintenance activities and future development. Typical Record Drawings contain- Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow.reserve dralnfield,existing and proposed buildings,location of wells,waterlines. wells,observation ports,cleanouts.and other maintenance access points. Incomplete Record Drawings may Create additional delays in final installation approval and related permits. ( ecord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that!installed the system in accordance with !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 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. rJ3i) 2� a Signature of Installer Date +� ••", OF 7 4.1 , Printid Name of Signee • ca MASON COUNTY PUBLIC HEALTH 'd4,4 1 The undersigned approves this Installation Report and � 9� Q►t9 Record Drawing on behalf of Mason County Public � ; Health: . tvZ5 eNti.,ftron -1 lJ Lam' Signature of Environntental Health Specialist Date (stamp, slgnatu and date THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8V21l201E U t f Y I 1 O 111 �y_ Ar �e PL D 2 Sr- 1CJO — QO _ • Cr).. O I • (nzt0oD 1,, cF z wrzl ci = , . -.ALE PL m z rrl CD (A r ;PJ m) 4. co _ o II C rii co (0 0) :"•:i § .e:4), _-..--"Er--".,17:iV CD NI Co -*" CA 9)5) I.---; i * %*', ,.i? 07 t _ % (TI i N z n I o z co cp k t al S 00'44'00" W -- I 330.75 ! 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Oc O� z CO0 010 ,41. ~rri n z "'r- 0 D E PARNELL ENGINEERING,LLC Hunters tn.S.E. 0623 HECORD DRAWING 5/28/25S.E.aN„Pb,WA 96513 ENNIFER CHANCELLOR 21109 (360)491-3243 SEPTIC DESIGN PARNELL ENGINEERING LLC SHT 1 OF 1 K WIZ a y ' LO SALE PL m P 1 rnPr-� � 1 I )3 ry y P ? N ray Z co I m o onov cn� m�� !!sue m g V CO -°' 0 P I'''.-- i � m �'F o m c) z y % z co CD (n p o O X A t X) S 00'44'00" W — 1 • 330.75 ii W MEADOWS PLACE w • 1_ y - - - - - - - - - - — — - N D z H Q 13 -T� I C /V I 30 U) IN rn cri - U Z rn I 0 I 0 . • • ,:. 1 m1 ro i I T°o rn O- — i °)#7/ °F. rn )0 O r- 'c I ,9irt '--3 O y • :..) -- o i I c C 0 I . 0 • '� 1 1 Ili co I4. �r -U I Ct y o ,u 1 ,s*V I ` V .11 .9'i'f► I W CO .4.' 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