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HomeMy WebLinkAboutSWG2024-00003 - SWG As-Built - 12/4/2025 � • Mason County OSS Installation epCort pgb.i 1nS 1— (0 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2b2\1- QI�pU Parcel # 32s I(• _. S'1 -- C' l p(A Applicant Name fibt�e,i.._ ('j ccr Subdivision (Name/Div/Block/Lot) Applicant Address po px 2t City. State. Zip Ct, ,rf o v6\kJI LA qk' 7 Installer Name k &*p,, Site Address 3316n OS LcWy 10l Designer Name cekrtr\ \'my" INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only Vepair ❑Other System Type A F Pretreatment Type nuwater Da- >5 ft. from foundatio t; 11-W-E- N/A Li ES ❑ No >50 ft. from wells? - -II �OV Vs ❑ Z >50 ft. from surface water? - Z kui S_ ill ❑ LVO ❑ < Cleanout between building and tank? - - - ❑ EA ❑ U Tank baffles present? - _ _ _ _ _ % ❑ Ft ❑ d24"access risers over each compartment?- ❑ L��f ❑ W Effluent filter installed?- ❑ no ❑ cn Septic tank capacity (working) ISN) gal Manufacturer 0r-e,C(1,6\- 5 D-box water level and speed levelers used? - - ?NIA ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- . ❑ 1E1 0 QQ �•2S Check valves installed? - - El El ❑ 2 Transport Line Size 4 t 'l Schedule/Class ��,� "a Bedrooms installed (check one) 0 2 ❑ 3 0 4 0 5 ❑6 rcilt ommercial/Other >10 ft. f-om foundation?- - ❑ N/A h'')YES ❑ NO O >100 ft. from wells?- - ❑ L O 0 >100 ft. from surface water? Elg El L.T. >10 ft. from potable water lines?- ❑ 0 Q > 5 ft. from property lines and easements? - ❑ uY} Q > 30 ft. from downgradient curtain/foundation drains? - - ❑ ElDrainfield level and observation ports present . Graveless chambers or0 0 ❑ El gravel used? (check one) �'� 64 Proper cover installed over drainfield?- - ❑ V ❑ Pump tank setbacks consistent with septic tank? - ❑ N/A YES ❑ NO Y Pump tank capacity(flood) kat,o- gal -,3am Manufacturer \ p(eik 2 H24" access riser(s)and accessible from surface?- - 0 W 0 d Alarm or Control Panel Installed? - . ❑ IST ❑ 2 Control Panel equipped with Timer/ ETM/Counter- ❑ TY ❑ m d Pump installed in ❑ Bucket or 171)On Block or 0 Other • Pump Make/Model CCQX\C p 2 d\On ID Floats or ❑ Transducer TA� a. Tank draw down in/min Pump capacity ►►�1 gpm Squirt Height ft Pump on time .. MNr1 Pump off time '2... ` %. Daily flow set at_1 10� gpd ...a3 e_°2'2_-a -411111, Mason County OSS Installation Report pg. 2 Parcel # 3231Q � l- O 1 0) 1,1. ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES NO If yes. please describe: Were all components purnped out and properly abandoned per WAC246-272A-0300? - - OYES 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. T1;;cai Recorc 2iawings contain. Dra.nfielo 8 ran`old onertaion& a e_: Sec:c.d:.:nno tank boaton.tonn a c.: reser.e as 'e c ex:strg and ordposec o„..-gs 'ocat on c'weirs.waterlines e'!s.observa:wn;arts cleareuts and ether-a-:enar.ce access Pans. Incomp e:e Record^u-awirgs may c•ea:e ace:oral delays in final:ns:a.a::on ap 'ovai an:re:ated perm ts ® 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 and attached Record Drawing is accurate. form and attached Record Drawing is accurate. nature of Installer Date bre- V\k v\R - 1 11 5 Printed Name of Signee - , MASON COUNTY PUBLIC HEALTHY, The undersigned approves this Installation Report and v:?� ;;, Record Drawing on behalf of Mason County Public • MAGI J.HUNTER Health: •rrF•FmNrrs• F Signature of Environmental ealth Specialist Date (stamp. signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE = ''" e''' o ® 000000000 N 22 N O Rl X D N m D �, � - i C - al 8 -n - 0 . . 0 v 0 m O Z Co 0 r O Z ► r Z 0 = x 0 0 r -+ Z N m T N A > 7C W c m W m m 0 c 0) _Ch M IV u m O m = D O g K Z X/ N A 0 W 7ZC p 0 8 w itiLft m bbT (, W O N ill m m 'i z z 7 m ? ` v cn xi O Z C N N �.� T r >< N 8 r C T Z N Z.71 in co a o r as:o Z I. 411* w Co m ° m v n N F • ____ O , __ , m� _ 7 3 ir i 11 - n ;-�a` 58 o O 0° O 8o 0 / ® 0aI1I! ! �, : z c O m Z IV CO / , 38.5. v rn • ono � iiiii � l). 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