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Home My WebLink AboutSWG2025-00004 - SWG As-Built - 1/30/2025 ' Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION (� Permit Number SWG LO J ^ M-)C)U Parcel# LA Z 2.)Z- 51 - U((?- Applicant Name �)m;iA S\SY- Subdivision (Name/Div/Block/Lot) Applicant Address 9.% k il-m() Sk . City, State, zip DWI\ G$$$y Installer Name ShOne MAM Site Address C\6 V Designer Name 'W CA ,,/ INSTALLATION CHECKLIST ❑ Full System Installation wl Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type j.NL�V Pretreatment Type >5 ft.from foundation? --- -- - - --- n`pn El WA ❑YES ❑ No >50 ft.from wells? --- ----- - --- � �� 4"_ ❑ ❑ ❑ Z >50 ft.from surfam water? -- - - -- - - BAN -� � - ❑ El ❑ FCleanout between building and tank? - - --- - -- -- ---- - ❑ ❑ ❑ V Tank baffles present? -- -- - -- - - - - — - - - - - -- -- El Cl ❑ a �24"access risers over each compartment - - ❑ ❑ ❑ W Effluent filter installed?- --- -- - - --- - - - ---- - - ---- - - -- ❑ ❑ ❑ fM Septic tank capacity(working) eat Manufacturer C D-box water level and speed levelers used? - - - ---- - - ---- - - ❑ WA ❑ YES ❑ No J 00 Manifold/D-box accessible from surface?---- - ----- - ----- - ❑ ❑ ❑ IQ= Check valves installed? - - - - - - - -- - - - -- - - - - - - - - - --- ❑ El ❑ ca S Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 P3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?. - - - - - -- - - - - - - - -- - -- - -- - -- ❑ NIA ❑ YES NO G >100 ft.from wells?-- - - ---- - - ---- - ---- - - ---- - -- - ❑ ❑ ❑ W >100 ft.from surface water? ---- -- ---- - ---- - - ---- -- - ❑ ❑ ❑ LL >10ft.from potable water lines?- ------ ---- - -- --- - - -- - ❑ ❑ ❑ QZ >5ft.from property lines and easements?- - - - - - - - -- - - - --- ❑ ❑ ❑ K >30 ft,from downgradient curtain/foundation drains?-- - - - - -- -- ❑ ❑ ❑ Drainfield level and observation ports present - -- - -- - -- - - - -- ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over dreinfield?---- ----- - - - - --- - - - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?-- - - - - --- - - -- ❑ NIA le yES ❑ NO Y Pump tank capacity(flood) 90 1 Manufacturer Q24"access riser(s)and accessible from surface?- - ------ - --- - ❑ El!- IL Alarm or Control Panel Installed? --- ----- - - ---- - - ----- ❑ ❑ 2 Control Panel equipped with Timer/ETM/Counter-- - - - - -- - -- ❑ ❑ 7 a Pump installed in ❑ Bucket or eon Block or ❑ Other �' a Pump Make/Model -Cbemy N�` 45 y! Floats or ❑ Transducer f d Tank draw down in/min Pump capacity opm Squirt Height ft Pump on time Pump off time Daily flow set at opd UWeW M1121118 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -- - - - -- Qf YES ❑ NO If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? - - --- - - - YES ❑ NO RECORD DRAWING Iris la a pentium-1 mumn,and must M accunr.and daacrlpuaa amm,h ra reaawla In Me need at amuniu.rca a dwir and Imme ammit menL T,,r Re Dramm,swmam: erainf*Md Mary Mmlamatlon81eywtaeptU,,lankbalm,NOM artcw,reecrve tlreinfiaN.evlaYng aM rygrosed EuiWingc.lwenon Nwells,welwlires, wells,Me¢rvallon pHs.ckamum,and oNm maimmmmv awess pana. In¢mpkce RecoN Dmueinga may aeale ad 0mal dams in fimW nambann tip mya am rtlmetl mu,u%. 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. - '--Lf \j'?'0z5 Signature of Installer Date 5hC> p " ao\P S Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updned arztaole RECORD DRAWING continued D. F• APPROVE [ JAN 3 0 2025 MASON COUNTY ENVIRONMENTAL HEALTt RET S x 2 . > e `1 al.rh oax on Po5 re)cl o e {o I'a�KS �QaJ Zfk , ,