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HomeMy WebLinkAboutSWG2025-00311 TRANSPORT LINE MOVED - SWG As-Built - 9/5/2025 : c _k? K. 1.4ocql Iran 5, Of l(V- se.::- .....%-., O2 Mason County OSS Installation Report pg. 1 MASON COUNTYL ©TH APPLICANT/ PERMIT INFORMATION Permit Number SWG 202C - OL31k Parcel # Lp.`gol- s'L- U 0 U 0 Applicant Name 1.0.M.\ . vc Subdivision (Name/Div/Block/Lot) Applicant Address ?;() L.Je\k ScAmoAtrrvi City. State, Zip ((WA. 1iR Q8 ccf l Installer Name {-;-(a�aZ C1krS (kV- Site Address Dv W eNAk .Sc,vc\c\ t 11-. Designer Name INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair [ ,Other h.-6 l ( iW. System Type Pretreatment Type m()t;e,a >5 ft. from foundation? - - %N/A ❑ YES ❑ NO >50 ft.from wells? - - ❑ ❑ Z >50 ft.from surface water? - ❑ ❑ FQ- Cleanout between building and tank? - - ❑ ❑ o Tank baffles present? - - ❑ ❑ f— 24- access risers over each compartment? - - ❑ ❑ a W Effluent filter installed?- ❑ ❑ N Septic tank capacity (working) gal Manufacturer O D-box water level and speed levelers used? - - I1N/A ❑ YES ❑ NO J DO Manifold/D-box accessible from surface?- - ❑ ❑ [OZ Check valves installed? - - ❑ ❑ /J//11 �E Transport Line Size I Schedule/Class 4 Give l v Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - B N/A ❑ YES ❑ NO O >100 ft. from wells? - - El W >100 ft. from surface water? ❑ ❑ u. >10 ft. from potable water lines?- - ❑ ❑ Z > 5 ft.from property lines and easements?- - ❑ ❑ Q cc > 30 ft.from downgradient curtain/foundation drains? - - ❑ ❑ CIDrainfield level and observation ports present - LI ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - a ❑ ❑ Pump tank setbacks consistent with septic tank? - - 1102 N/A ❑ YES ❑ NO • Pump tank capacity (flood) gal Manufacturer < 24- access riser(s)and accessible from surface?- - ❑ ❑ ~ Alarm or Control Panel Installed? - - ❑ ❑ a ❑ ❑ 2 Control Panel equipped with Timer 1 ETM /Counter- - 0 n- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other n- Pump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd uaaa:e3 8 r 2 Mason County OSS Installation Report pg. 2 Parcel# v ` I0 G Z '3c ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES 04 No If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES NDNO RECORD DRAWING 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 Drawings contain Drainfield&manifold orientation&layout,Septic/pump tank location.North arrow.reserve drainf:eld existing and proposed buildirgs location of wells.waterlines. wells.observation ports.cleanouts.and ether maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related peen Is. Wac S C, \vhOr t►\-1 -- iv)weU 6t4'OL3LOOezo 414C1 ZRUOo;v 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 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 nd attached Record Drawing is accurate. form and attached Record Drawing is accurate. i nature of Installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH , The undersigned approves this Installation Report and ;,... . Record Drawing on behalf of Mason Coun,y Public S�p ` " Health� /Y/ 0�� Z� F,y�j,•o S Signature of Environmental Health Specialist Date ✓,� N'�FN0q� (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW,I THE MASON COUNTY WEB SITE j'�'''"e`t . %la A uno3 uoseyy tuck")Pa1uud sWa i(iunoa uoseW WOJI pelU!Jd 4 ,44" , /24 ''.• , + ♦7t O i '''',..„.................., .:** Oce; N It !�,t 'Qu. 1 . < ON`1. 10 s 9 W = R W Y O cp J-- C. W Q , CL ` IIa 0 \\. • p Q O, ; CI , at.: 0 ; 1 itill - rrys„z ,oyI ,DOS i-... F iffl 2 ,f'�`. g i g ------...1"Vi/ 1;c4 r 1-. v L 4. S Q {.i. 2' v s i 1 ti 5; 0 I _ Iv - >- () IL• OS i 1 wz IZ wa� .eg a Ee.. U < t7L. ° C '44e t-4 twF- ' zoza wta- o la t)1 Q17.1 w /- V) V) :,' vv,n.=dz v, ,oa/