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HomeMy WebLinkAboutSWG2023-00041 - SWG As-Built - 5/27/2026 Mason County 0SS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG l CL.S - GO C•`\\ Parcel# 22.\ 2J Applicant Name ..,r;r i(.� 1 \o)J Subdivision (Name/Div/Block/Lot) Applicant Address -3 S71, /L t t h i1 . S. City, State,Zip (—r: tJi 3 Installer Name C'' v';c, t ).�t. Site Address ``>&C) /!f f„L., ;, = i�: Designer Name r . r' INSTALLATION CHECKLIST ❑Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type }"\ treatment Type >50 ❑N/A [7J YES ❑ NO ft.fromwells? ---=---- 19------ ❑ Q ❑ >50 ft.from surface water? -- - - - ---A--,-- + rL -- ❑ © ❑ Cleanout between building and tan - "\3_tY-- ---- - 0 0 ❑ Tank baffles present? ------ - ------ _- _----_- ❑ El ❑ 24"access risers over each compa ?-- - __ ❑ 0 ❑ LUEffluent filter installed?-- ---------- ------------.- ❑ Q ❑ Septic tank capacity(working) )s;i,t.0 pal Manufacturer t f. i r•'-- ® D-box water level and speed levelers used? -------------- - ❑ N/A OYES ❑ NO QO Manifold/D-box accessible from surface?---------------- - El ❑ ❑ Check valves installed? - ---- ----------------- ---- Q ❑ ❑ 9 Transport Line Size %tom i ) Schedule/Class 3 i' 3 L 1 Bedrooms installed(check one) 2 3 L]4 ❑Commercial/Other >10 ft.from foundation?.- --- ---- ------ ------- 0- -- -- - - -- --- NSA ©YES ❑ N0 >100ft.fromwells?-------- --------------------- ❑ Il ❑ >100 ft.from surface water?--- -------------------- - ❑ ❑ ❑ uu. >10 ft.from potable water lines?- --- ----------------- - 0 ❑ ❑ Z >5 ft.from property lines and easements?---------------- ❑ 0 ❑ >30 ft.from downgradient curtain/foundation drains?--------- - ❑ 0 ❑ Drainfield level and observation ports present -- ---- -- ------ ❑ p ❑ J Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------ ------------- ❑ ❑ Pump tank setbacks consistent with septic tank?------------ - ❑ N/A ❑ YES ❑ No Pump tank capacity(flood) gal Manufacturer Z < 24"access riser(s)and accessible from surface?------------- ❑ ❑ ❑ iL Alarm or Control Panel Installed? -------------------- - ❑ Cl ❑ Control Panel equipped with Timer/ETM/Counter ---- - - - --- ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Pump Make/Model ❑ Floats or ❑Transducer Tank draw down in/min Pump capacity qpm Squirt Height ft Pump on time Pump off time Daily flow set at qpd Jpd5.ed w2irzo,a S. Mason County OSS Installation Report pg. 2 Parcel# - _l�G a o �a ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- ❑ YES ❑ No If yes,please describe: Were all components pumped out and property abandoned per WAC246-272A-0300?-------- ❑ YES ❑ NO RECORD DRAWING This Is a permanent record and must be accurato and descriptive anougb to rectorate in the need of maintenance activities and Future dovetopmenL Ty cat Record Drawings conlain: Drainffreld&naniteUU orientation&layout,Septidpump ten4 Ihxation.Nodh arrow.reserve Bran Seta.exstmg and proposed bur3di gs.location of pvAc watatrnes, wells,observation parts,cieanouts and other maintenance access pains.Incomplete tad Drae,mgs may yeas adddional delays in Foul installation approval and rofeled permits. 'Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER t certify that!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 Healtlf and meet all and Mason County Codes. State and Mason County Codes ,. 1 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. - 2 - 2� Signature of Installer' s ≤t Q; �^� 4ek( / Printed Name of Signee ,p' � { Fs MASON COUNTY PUBLIC HEALTR 'l„ OO 4r` J j4" The undersigned approves this lnstallati�ry eport?nd 03033 J Alton 3--y Record Drawing on behalf of Mason County4pblic , LI ENSED DESIGNER Health: , O,y <2 2 ^2 SZ z z �F2q Signature of Environmental Health Specialist Date - 111l (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ° rn018 AS-BUILT r---------------------------------------------------- N 3 ' 35'50' Attenuation ne 46 50' 50' 18�' to PL 1 2 bedroom .z M Cabin #2 I 51, Th#1 'I,,.:P II I oo slope i i jI h20 Line I I ►, Well ; I - I ; power ` I "— Area of Detail Date: 6/4/2023 Design Stamp Designer Info: Applicant Info: Page Jim Zi mny Warren Hoss APD NE Tahuya River RD y 7178 Windflower PL NW #322127600050 7 2' L Scale Seabeck,WA 98380 ���� ' r 50' APDdesigns(�icIOlld.com E V1RO EN�A�HEA�Th = • Z