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HomeMy WebLinkAboutSWG2024-00327 - SWG As-Built - 11/5/2025unmoor. . Dc-'E gr,E .ielop;!f.E3B07A87-E976-4381-825A-82DE7061928F Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00327 Parcel # 220055500021 Applicant Name Moore anri Rrooks Family Trttst Subdivision (Name/Div/Block/Lot) Applicant Address 77 1 WII fF1 fWFR ST City, State, Zip Kingman A7 86401 Installer Name Skinner Construction Site Address Inn F Willrhar RI Vfl Designer Name ,lim Hunter INSTALLATION CHECKLIST I © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair 0 Other System Type Pressure C1'a 14Y1 YASZi Pretreatment Type Glendon >5 ft. from foundation? - - 0 N/A a YES 1 NcE-7;c? 0 >50 ft. from wells? - z t Z >50 ft. from surface water? - - 0 El ❑ c H Cleanout between building and tank? - - 0 El o �_ o Tank baffles present? - - ❑ x❑ 0 I=',1 a 24" access risers over each compartment?- - 0 El El W Effluent filter installed?- - 0 x❑ FA cn Septic tank capacity (working) gal Manufacturer reen Precast I 1.k.0 - -') 1200 FvPr9 o D-box water level and speed levelers used? - - x❑ N/A ❑ YES 0 NO oOJ Manifold/D-box accessible from surface?- - El 0 u. C92 Check valves installed? - - 0 x❑ 0 oQ E Transport Line Size 1 in Schedule/Class Schd 4n Bedrooms installed (check one) 0 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - 0 N/A x❑ YES 0 NO O >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - El El • >10 ft. from potable water lines?- - ❑ x❑ ❑ Z > 5 ft.from property lines and easements?- - 0 x❑ ❑ w > 30 ft. from downgradient curtain/foundation drains? - - 0 ® 0 • Drainfield level and observation ports present - - 0 0 0 ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 x❑ 0 Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank capacity(flood) 1500 gal Manufacturer Fvergreen Precast Q24"access riser(s)and accessible from surface?- - 0 0 0 ~ Alarm or Control Panel Installed? - - 0 0 0 a 2 Control Panel equipped with Timer/ ETM /Counter- - 0 ® 0 D d Pump installed in ❑ Bucket or 0 On Block or © Other Pump hasin a• Pump Make/Model l iherty Ft 31 ❑ Floats or x❑ Transducer a Tank draw down 1 in/min Pump capacity 24 gpm Squirt Height NA ft Pump on time A SFC Pump off time 14M s2S Daily flow set at 27n gpd Updated 8/21/2018 DoGusign ci,nveloe:p: E3B07A87-E976-4381-825A-82DE7061928F Mason County OSS Installation Report pg. 2 Parcel # 220055500021 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - D YES Q NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES El NO 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 drainfield,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. 56.1j ?,/r o0X) 1.4:) Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER 1 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 opiggatOched Record Drawing is accurate. form and attached Record Drawing is acc ate. -lJtbJ'33WALdA.1 Signature of Installer Date Arl!, �! '/ ,1 , (0 . 30,'5 SAMUEI gKINNER Printed Name of Signee f�v '4,1I § g 11:1-..A MASON COUNTY PUBLIC HEALTH i�� ��+ 73 The undersigned approves this Installation Report and � sl IJI , IAMB It MONTH 1 Record Drawing on behalf of Mason County Public AP LICENSED DESIGNER �t Health: ♦ 411%��%•74010101‘,1, EXPAttS: 03/22/.V(o (\ [5-/%c Signature of Environm ntal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 • liN ,---------- _ , r , - • : - 1 ---1 , 7.121,— ; ---, .3 --si .7 /,-- • i /z/ '1? _........---, 1 . i // o O q . 0 a. -r_ r -54 .,,/ , . r. . . • .. --1 ... ' 1 -. 1- cil cD, 37 i . 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