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Home My WebLink AboutSWG2021-00368 - SWG As-Built - 7/24/2023 c-' ( Ty rJ''/ + 1 b1y- ke v/fetal i2ecoicd J 4 ' rG o A-Ikj,_j_ Mason County OSS installation Report pg. ' CIA^ Aci t =OlLINTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION i Parcel# 22-/U-oe oc)0 Permit Number sJ�,� r�'(�,.,?/ - Do 3� (�f �_ Appl ame Han r Subdivision (Name/Div/BlocklLot) '/I:; l;it A dress L1//v ,s/ I .)'/' ' C..i V i., :r• ((. -y i.'i /OW Installer Name < t1./ 4.V.,:4 2'. ift—' \ , i\, r i t reS: C �•/ c ' Designer Name t?i nc-t t.JG't ,._-_ 10 // INSTALLATION CHECKLIT _),, uil Sys;eu: i+•,taliation ❑Tariy<(::; Only ❑ Drainfia!d Oni} j Repai ❑Other ystem type _ _ Pretreatment Type >5 ft. from foundation, - - - _. _ - - - - - - - - - . - - - -- - - - - - - - ❑ N/A li--,, 'DES ❑ NO $>50 ft. from wells? - - - ❑ ❑ Z >50 ft from surface water" . . - - 0 1 0 i 4 Cleanoul between building and tank? - r kt�R-N•�' oyft 0. ❑ ❑ ❑ 0 Tank baffles present? - .. - - - 0 T ❑ 1 24- access risers over each compartments- - - 0 E+ 71 ,W Effluent filter installed?- � 9 ❑ 14.1 r� Septic tank size_Ian gal Manufacturer t"to U_re_ 1 tr-«-i-ii+L-t�-- ! © D-box water level and speed levelers used? - - - - - ❑ N/A YES ❑ NO 1 •00 Manifold!D--box accessible from surface?- •- V - ❑ LJ GZ Check valves installed? 0 II ZTransport Line Size '9Ii Schedule!Class;OM Bedrooms installed (check one) 0 2 71 3 ❑4 0 5 ❑6 0 Commercial/Other >10 ft. from foundation? - ❑ N/A K VEs El NO y 0 >100 ft from wells? ❑ ❑ -1 "00 ft from surface water?- ❑ M ❑ W Z >10 ft from potable water lines?- - - 0 ft from property lines and easements? 0 R Ci > ti> 30 ft from downgradient curtain/foundation drains? - _ - - - - - - • 0 rg 0 0 f • Dra,nfieid levee and observation ports present ❑ i� il I Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 'ii ❑ r iPump tank setbacks consistent with septic tank? -• - 0 NIA 0 YES •NO Pump tank size gal Manufacturer - - __---_.-. i < 24"access riser(s) and accessible from surface?- - -- - - - - - ❑ 7 0 D• 'r r. o !''A 1 i Installed? - _ - - - - - - - . - - _-- - - - 0 ❑j� Li �, 1 Cont'•1 . with Timer! ETM/Counter -- - - - - 0 —1 ` M ti g ip�i tal iri ❑ Bucket or 0 On Block or ❑ Other __.__.___� I ty L [[ _; Floats Or ❑ Transducer MAS t'N ump MaKeiModel_ — r u►� ENVIR a T2nk �yQh g AL_HEACTH in/min Pump capacity- __ _,_•__._gprn Squirt Heightt ft P r!.. •n time Pump off time wily flow set at gpd / Jokn4' JO IAA Hon a53,‘,04.. Gil? i Mason County OSS Installation Report pg. 2 - Parcel# r ABANDONMENT RECORD Were existing septic components abandoned as part of this projeor ElYES X NO iIf yes. please describe _ -- Were all components pumped out and properly abandoned per WAC246-272A-03007 ❑ YES NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re locate in the need or maintenance activities anti lit rr development lytscrrt Record Drawmus contain Dramheid S.mar+rtold or:entattor$err,a ',oft/pump iena location Nutt arrow reserve dratrtrtetd t•ntstal°and proposed I• its.kx:ahon o1 we!Is wateli!nea waits obsorvahon ports durmasts.and own mamtr••..: . .cv pant. Incomplete Record Drawings may create eadntoetrr.?ways in tint c;.,.b..'icnt approval and related permit. tl �t 1 `U -� 0 f u de �e i' id Al&X t A-/ CD A--'r cY /,/ „Ai1„ /l�lY1a i Rxe�- se."/ (pry, a Yfsc wa f s}rtK IJ.)...) d airfu ►24,�N,.,f a-,,,.., ,.�oi� 1, ftc..4 vatic/ 1i•pvi d .?1 11 5 WJ ) kl.� bead ,4) A cue,{. - �{{ tecord Drawing Attached i �' -J CERTIFICATION OF INSTALLATION INSTALLER : DESIGNERJ ENGINEER I certify that I installed the system in accordance with I certify that the system has been installed in actor the septic design stamped'APPROVED"by Mason ' dance with the septic design stamped"APPROVED"by County Public Health and that any deviations shown i Mason County Public Health and that any deviations here have bean 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 Slate and Mason County Codes I farther certify that all information contained on this I further certify that al.information contained on this form and attached Record Drawing is accurate. r, form and attached Record Drawing is accurate. tg..."1"0",......001""' i 2.1[141A 1 .i ! Sf ne or install r Date 1 4. e __ L. <Is,� elPunted Name o Signee " MASON COUNTY PUBLIC HEALTH • y sto s "AF� the undersigned approves this installation ltiepod ai11 2 4 2023 LICENSED DESIGNER Heolt MASON COUNTY ENVIRONMENTAL HEALTH EX"Res onto, 7/2`1/Zoo DJA Signature of Environmental Health Specialist stamp.! signature and date) a THIS FORM MAY BE SCANNED ANi:.AVAILABLE FOR PUBLIC VIEW ON THE MASON COUN i Y WEB SITE updatndti "v24•P •0" • co r . z. y n r 13 „J z O ��N tit r F 4ir)It..0)4 y 7 mI N-v, �qc qA.V. Nt G,, ,tom, Viv'& o v 2% m o,o d�' z m .. t �.5 e - • Ili , w„ • • w N.l...)..., ..,,,. s., ' : 141.r . : . / ,.... . .. ,... .: . .. 44. ' ." : 5i2- ,"•re. -- ) ;. i • • 111, Cat.pod' s•. • 0) 6-6 b l'si • • • CPW • 0 Pere,co r I P Pi.ypaiti Dr(3°'/..042-- -, i coPit.aporei rhgr ( 7UI ,C/ ..... DLa 1 id 6 e'il d IX' - ..t\ ik )--(----, --- 1 - e 4 e_. -toy0 i A1 - / 71..... • of I — .., L ...--- __._ .. ___F ____ ,A--- ---- ------ S.0 ' ___.---- e .. (c• 4 4. 'dy„k1 A' ,°,C.i 'lb % _ ,e ,4,4_4.,, g - '4.0 1, 4.,:e2s 510.•18 `''4 ie / 17 1 e ew-fv LICE SEDoNER ALILILILIILIIL1MILIP.mmir IL Illeimorm t\ 13wre P ./),)1 i E:PiRES 05/101 )0c. Ofrta q 1 Al &I r;ri arl r r 7 kt,t<le r,r r I D i,f tci A "PROVED _.._ --T- I JUL 2 4 2023 ___. _ . CD1-0, I (2..„ [Li MASON COO Ty,,, 1 1 6, II t ."'.. CPIVIRON DJA MEN/.„ AL HEAL 772 , 1 A PPRovE I MASON COUNTY EMIRON:''611:\i rA; ' :7 'Zi/ . ii-14- VS . AU° 03 2071 _._ Jatov ...... Illai AJia.tto le Jele ilLirP) II irk, ft avi/-if K., 3 oyth,feuv ..?e, •I.I. \ --i---7I I. ,.) e At, cilL.4.4 AP trek).