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HomeMy WebLinkAboutSWG2022-00028 - SWG As-Built - 12/4/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 20 2. ,1 - C.•i L L- ''� Parcel # ;S Lt 2_7 - rq_ CC. t>7 7 Applicant Name f ( AA 1/6.4-kari.(..z tt+Ac:ii iv,u . I Subdivision (Name/Div/Block/Lot) Applicant Address k71 f, r ci�l,t I2C City, State, Zip ;S}Z,i,1 '1 (,u4 �1N'1'�tf Installer Name ( _.:tk_ �-);f;i�>r�i- 1 ti' •1 '' f; E i ,) Designer Name (- v.; \.f u '. A t -L. Site Address l �` . i�- : 1 .1(��•�`1 ;� : ' INSTALLATION CHECKLIST Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type T/ZeSScid -, L7'S1- ' -treatment-ype >5 ft. from foundation? - ❑ N/A ElYES ❑ NO. >50 ft. from wells? - ��- Ni. ❑ ❑ ❑ • >50 ft.from surface water? - t- - -rat- - - 0 El ❑ Z < Cleanout between building and tank? - - I��' - \ ❑ ❑ ~ U 0Tank baffles present? - - - ■ ❑ 0 a24' access risers over each compartment?- ! - - - - - - - ❑ ❑k ❑ `W Effluent filter installed?- �� - - El El Septic tank capacity (working) )7.`,( , \t: Manufacturer i:': _0 D-box water level and speed levelers used? - - [ J N/A ❑ YES ❑ NO XO Manifold.'D-box accessible from surface?- - NI ❑ ❑ mZ Check valves installed? - - 0 ® 0 6Q 2 Transport Line Size 2 Schedule/Class SG\, 4t) Bedrooms installed (check one) ® 2 ❑ 3 0 4 ❑ 5 ❑6 ❑CommercialiOther >10 ft. from foundation?- ! - ❑ N/A ® YES ❑ NO C3 >100 ft. from wells?- 4 - ❑ lI ❑ W >100 ft. from surface water? - - ❑ [4 ❑ u- >10 ft. from potable water lines?- - ❑ ❑ z > 5 ft. from property lines and easements?- - ❑ ® ❑ Q IY > 30 ft. from downgradient curtain/foundation drains? - - ❑ Gii ❑ 0 Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers Or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ IZI ❑ Pump tank setbacks consistent with septic tank? - - ❑ NIA 5i1 YES ❑ NO Pump tank capacity (flood) 1/oa gal Manufacturer 1-PC) rWe a re ( -F(4.3) z 0 ❑ < 24" access riser(s) and accessible from surface?- - ~ Alarm or Control Panel Installed? - - 0 ❑ 0 2 Control Panel equipped with Timer/ ETM /Counter- - 0 ($l 0 A, a. Pump installed in ❑ Bucket or ❑ On Block or 0 Other___-- _____________ SPump Make/Model tat: r'. 153 jit Floats or ❑ Transducer d Tank draw down 2 in/min Pump capacity G G gpm Squirt Height _ 5 ft Pump on time .- `-1 Pump off time__ 1o`xS 04" Daily flow set at_ __gpd .cJ f'a l i2 1 6A 4"IfZ i 6 h r41 c-g e, rie"e,• - Cc Mason County OSS Installation Report pg. 2 Parcel# IABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - N YES ❑ NO If yes. please describe: IWere all components pumped out and properly abandoned per WAC246-272A-0300? - ® YES ❑ 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. Ty;ica,Recoru Drawings coma:r. Drainfielo&manifold orientation&layout.Septic/pump tank location.North arrow.reserve drainfield.exist ng and proposed build.ngs location o`wells.waterlines. .'el's,ebse st•c^.:ors c'eancus a^o ether maintenance access points. Incomplete Record D-awings may create additional delays in final installation approval and related perry Is. 0 r aw4. /Cell` Al G QVO J ve L?, ,,-►' t'„, so ex 0,,el ❑ Record Drawing Attachea 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 and attached Record Drawing is accurate. form and attached Record Ira wing is accurate. ei& Sign re of Installer f� Date ill i. 00 4 JOG r/0Uy� oaf 9 f - Printed Name of Signee .ii ~ 4. ti, �. ' s• n4 � • 1 •MASON COUNTY PUBLIC HEALTH �� 5t t. : ,� � The undersigned approves this ln$tallation Report and f LI .' E SI•GNff� Record Drawing on behalf of MasOn County Public ..�*►+ �P.���Z •.w .w+, ,�13 Health: EXPIRES o5,a id7\QA(ity COI r q(4/ S-- Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIE'A'ON THE MASON COUNTY.':EB SITE -7•11Ve1e k,a'••• i I \ ---________,474 i? \ —,.,________________. AT \Asa t h ii ���� c ,�, 'I+ �-v ll ,,,ffiq s 5 . 18 A .0 t, 1�"�' t \```� 1— © D .- LI D ES K?NERA +' '. Ill EXPIRES 050101 i ,, DEC 0 4 2025 30 `MASON COUNTY ENVIRONMENTAL HEALTH \.._ RET g Srie I/ ltvh+C ® ! 240 4 digit, Sir/'c 4-'44 C D 1 a-uti 7 ea/oil Id:" 't. ''4'"k 22-y '' oA Q Tx a 1, I I7 1 CO Gf , s /L., , \i, i__________,....!....., ----..1 :t--1 ?ere*41 a ace'o..., 0, (1) 1",4,1 et II we 7 0 g6 ' aileAk.do Ai 2_0 At-t ' 4 s ., ‘4110,4/ ® Va1v.e Rx (_ SL 111-_:: 3U' Pt04114#(Att-; oR /1 E. isjM4tNt . Rf .SL/ 0- 3L" L 41,... 000 g i rL2 e)- 4c. ,,,k__, mpi„,.., ("1",f ,4 1, I/ 10 ki-Vit... U- 32 9 . e.. 4' a "a 0- 7�'4 .ii 4-, h