HomeMy WebLinkAboutSWG2022-00137 - SWG As-Built - 1/6/2025 (2) Mason County OSS Installation ReportP9! MASON COUNTY PUBLIC HEALTH
A PERMIT INFORMATION
Parcel# 1 '2n 3C3f9�3<l
rApplicantAddresos
r Swc ZO ZZ d d t 7 Subdivision (NarnelDivBlockhL 0t)
e ^ J r i
I,L OO).,y
ress 1110 S .4yu4Yip 2 f9C. Installer Name
Designer Name(e0 ` d
INSTALLATION CHECKLIST
Drainfidd Only ❑Repair ❑Other_ __ --
Full System Instelistim O rank(.)Only
System Type
NIA $YES ❑ NO
>5 ft. from foundation? ---- ----- - - g ❑
>Sott. fromwelts? -- --- - - - JAN or_ _-- g ❑
Z >50 ft. from surface wateR .__ ____ ___ ❑
H Cla mout between building and tank? BL ❑
Tank baffles Present? ---- - - ❑ ❑
Fa - - - .24'access risers over each compartment7- -- -- - - - ❑ �. ❑
W Effluent filter Installed?- - - - -- - - --- " " ' " --
L? 4) sal Manufacturer
Septic tank capacity(working)_ . ❑YES ❑ NO
0'N!A
Op-boz water level and speed 2 ❑ ❑
LL ManifoldlD-box accessible --- - - - ❑ ❑
z Check valves installed? --- -- ---- - -
DC Transport Line Site 77 rte— ScheduWCWSS- --
Bedrooms Installed(check one) ❑ 2 03 ❑4 ❑5 ❑5 ❑CommerciaYOther
— -- ❑WA EYES ❑ N0
>lOft.from foundation?-------- -- " ---- -- �' ❑
>l0o ft.from wells?------- --- - _ - "'- - ----- ---- - - �C ❑
W ,loo ftfromsurfacewaten -_ _ _ _ _ _ _ _ _ ______ _ _ _ _ _ -" - ❑ �q�i ❑
a >loft fmm potable water lines?- _ _ _ _ _ ____ ____ ___ __ ❑
Z > 5ft.from property lines and easements?- -- - - ---- - - - --- O ❑
9 >30 ft from downgradient curtairdfoundation drains?- - --- - - - " ❑ ❑
im Drainfleld level and observation ports present -- -- -- - - - -- - - -
r0 �iraveIess chambers or ❑ clean gravel used? (check one) ❑ ❑
proper cover installed over drainfield?---- -- -- - - - -- ❑ WA gvEs ❑ No
Pump tank setbacks consistent with septic tank? -_ __ .
a !d
z Pump tank capacity(flood)_$C _91 Manufacturer
❑ ❑
24'access riser(s)and accessible from surface? - --- ---- -- ❑ ❑
O~. Alarm or Control Panel Installed? -- - -- - --- ❑ -B ❑
i Control Panel equipped with Timer!EN Counter. __ _ _ _ __ _ _ .
4 Pump installed In ❑ Bucket or 0 On Block or ❑ Other ❑Transducer
I
�,� 0 p1loats or
Pump Mak,Wodel r ft
V pm Squirt Height 3
Tank draw down rh Nmin Pump capac ty Daiy flow set at Pd
.Pump on Pump off time „v,.r,�„
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
-- - - ---- --- YES ❑ NO
WereexiNing septk components abandoned as pan of this project? -- - ❑
N Yea, please desrnbe'Were all components pumped out and property abandoned per WAC248-272A-0300? •-- ----- O YES ❑ NO
RECORD DRAWING
1NY ft.Mm••n^'e naaa.M coos be Clfl mid dncno.v.rough m rlac.e hi u n..a er nwnm.aaMa+tad iwn anw., .
0...a.cmn:om&Md a mmtM ar.m°am a Spa S.rc. aW ti,*a fn.Nam n1,m.wb.kle .ax g.ra pw°.�a+ra^Y. 'I.�enre WM.
weft.°bevtn pee,a.now.w daft m.iaenerc..rn..w*•. xmmgw a. e e.w.9.maye.ma mane delays
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I caddy that I installed the system In accordance with I certfy that the system has been installed in acwr-
the septic design stamped'APPROVEO'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 clearadlapprDved by both the designer shown hem have been clearedrapprovad by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codas. Stale and Mason County Codes
I funher certify That all information contained on this I further certNl'that all Information contained on this
form and a red Record cawing is accurate form and attached Record Orewing Is accurate.
12-Z3 Z1
Signature ofinstaser Date
Pdnfed Name of Sgnee
MASON COUNTY PUBLIC HEALTH _ n
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
I c l i'
signature of EnWonmerae 1 Health Spacleaet Date (stamp, signature and date)
NED ANDAYNt�eLF rpftpUBLIC VIEW ON THE MASON CDUNTY WEB SITE e ° n°I°
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