HomeMy WebLinkAboutSWG2022-00474-ASBUILT - SWG As-Built - 8/10/2026 Mason County OSS Installation RepA pg. l
MASON COUNTY PUBLIC HEALTH
APPLICANT!PERMIT INF0RMA0 ON 00073
Permit Number St''M'
2022-00474 parcelt
Bledar Kociu Subdivision(NamelDivBlo )
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Applicant Name 2 =
Applicant Address g,^ Installer Name Df
rL Ada r Hunter ane Ji
City,State.Zip S t aDesigner Name R nter a
-luoc1 lcr'+aM LdfS_
SiteAdtlress �---
INSTALLATION CHECKLIST
[�Full sYs dw+ ❑Tankls)Ddy ❑DramRdd OrRY
O Repair O
tent kWeaa Pretreatment TYpe��
System1itS ❑ YES ❑NO
❑ ® ❑
>5 R.from lolaidation? } w^ O
- } 5 ❑ ❑
Y >Sptifronsufacev2ter? ---- _QU�_� k111Zf1_ ❑ ❑
f
ca 'lding and tentd ❑ 0
Tank belles present?
O ❑ K!F 24-accassnsers over each Comp __________
tu Effluent filter instilled?------"- Maaafadlrter [
rn Septic tank capacity('roil'ing) i 4E5. _ �No
O p-box water level and speed levelers used? -------"" ----- ® ❑aceDO MaridbldlO'�xaccessible from s ❑
mz check valves installed? -"-- SdredWelClaas
O� Transport line Se______________ 3 ❑4 ❑6 ❑6 ❑commerdallONer
Bydrypn6 installed(died' ❑2 ® ❑ WA (DYES
❑
>lo R.from romdation?._________ -------- —
W >100 R.hen surface wateR- ❑ ❑
table water lines?-- "- --____. ❑ ❑
>70 R.from Po - ❑
_ hoes and easements?.________ ❑
Z >S R.from pro wog
30Rhom dowrgradient wnairVtoundaGon drairo?-- - ❑
Drair�eb level and observation pons "ate pie)
❑ Gam bers or ❑ Clean gravel used? (________. �] ❑ ❑
Proper cover installed over dreeiflNd7.__ ® YES ❑
❑ WA
Pump tank setbacks conslstentwah ØC tank? --'-"-"-- Pf
NO
�� n n Manuradurar ❑
Y PUMP tank capacity(flood) 1yal _ -- ❑eV''/ �� ❑
Q24.access dser(s)and accessible from surface?--_ ❑
Harm a Contrd Panel Installed?
S Contrd Panel egtjpped th Timer I ETM I Counter--- - - -- ry ❑ r r
WmV aBucket ❑ On Bieck or Other installed♦A O M �]Foa R
a Pump MakelModel Squirt Fleet ) rloats or ❑Trarmdur
-
f ,�.n !` RJmIn Pump capacity ��pm Daly Row set ate
U- TarRrdrawdown
PUMP Of time y__�
Pump on time �
Parcel
Mason County OSS Installation RaABANDONMENT RECORD
O tee to
Ia ebantlone0 e9 pan of Ihls pr ? ----'
Were exlstlne sapGc tar n � ym ND
H yes.Please aesawa: as and PraParh'abarWalad Par WAC2a&27TlW7W7 ._____
Ware atl conlPera:nla tamped
RECORD DRAWING su..w.M w...ww. w. Marrede
r m.n...a l.wnr..M. „ r+ n+.
Tw,r.TA�"K^m'a•r & of S4a�' " �"`""tlo"'" 'A .m4Sf'rnww �/J+min Ma Y.u1+bn.ovenl.�e Mlea o�a�a.
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Record Drav4rlg Attac7N:d
CERTIFICATION OF INSTALLATION
DESIGNEW ENGINEER
INSTALLER rdance wth I certiy that the system has been metal PPR ,by
1 ce sep*tic
I installed the system in acco Mason dance with the septic design stamped deviations
the septic Public
Health stamped APPROVED-by Mason County Public Health and that by va
deviations shown n rdeamd"p
County Public and that by by both the designer shown here have be Public Hearth end meet all
hem have be ckamd/ePHe et all State myself end Mason County
and Mason Coumy Public Health and meet State and Mason County Codas
and Mason County Codes' I further certify that all in/aTnetan containedte this
I further cattach at all information contained to this fob and attached Recall D..win9
Drawing is accurate.
form and attached Record _ 26
Ti31�if
Date ,c;,
at a elkr <-,
Pnnt� MrledSgnee �, I r�
MASON couwfl PUBLIC HEALTH Aourr HrR
TM urbaisl9ned approves this installation Report and `�L CFr SI"� 4
Record Dmwirg.behaff of Mason Comfy Public
cAv
tea C C
D'• / (stamp, sgmigum and date)
nest Date u.a+r nl.m�.
$IPNraa dErwaP^^Iaaa Haaah B SITE THE MASON CWNTY WE
THIS FORM IY BE SCCANN4 NED AND AVNIASLE FOB PUBLIC vIEW ON
) IRECORD DRAWING continued
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