HomeMy WebLinkAboutswg2024-00054 - SWG As-Built - 2/17/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2n2y-0a ON Parcel# q/902-71- 90 6o
Applicant Name �. Subdivision (Name/Div/Block/Lot)
Applicant Address
City, State,zip SWhYI, 1,10 gfJ?L1 Installer Name
Site Address U Designer Name
INSTALLATION CHECKLIST
[] Full System installation ❑Tank(s)Only ❑ Dminfield Only 91epair ❑Other
a
System Type pW)FE Pretreatment Type
>5 ft.from foundation? --------- I? Rn ❑ NIA EYES ❑ No
>50 ft. from wells? --- - ----- -- 1"r_?P.�� � - ❑ IR ❑
Z >50 ft.from surface water? ------ _ _ ______[_/__ ❑ ® ❑
IQ- Cleanout between building and tank? . -FE4 2-1-20_ ❑ ❑
tj Tank baffles present? --- ---- -- _ ____ _ ❑ ® ❑
a24"access risers over each compartm ___ _ _ ___- ❑ Iff ❑
NEffluent filter installed?- --------- - --- - ❑ ❑
Septic tank capacity(working) aR gal Manufacturer park&
C D-box water level and speed levelers used? --- ----------- - ®ryA ❑YES ❑ NO
O0 Manifold/D-box accessible from surface?--______________ - ❑ ❑
GQ Check valves installed? -_____ _ ___ ________________ ❑ ❑
2 Transport Line Size 2rr Scheduletclass 54 YO
Bedrooms installed(check one) ❑ (�3�4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation?-------- Tpp �_��F� WA ®YES ❑ NO
>100 ft.from wells?- - - -- --- ❑
id >100 ft.from surface water? ---- _
LL uj >10 ft.from potable water lines?---dip - g?S�Q�j ® ❑
2 >5ft.from property lines and easemen�------VIII FN"WEAtTr❑ ® ❑El
Q ��p
C >30 ft.from downgradienl wrtain/foundation drainOW- ------ ❑ 1� ❑
Drainfield level and observation ports present -------- __ ___ . ❑ ❑
® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over dminfield?------------------- ❑ ❑
Pump tank setbacks consistent with septic tank?------______ .1 `n❑ WAA ❑ YES ❑ uo
Y Pump tank capacity(flood) �_ b at Manufacturer { i�fPf'nd�
Z
f24"access ri"r(s)and accessible from surface?----_________ ❑
a Alarm or Control Panel Installed? ----- --------------- - ❑ ❑
Control Panel equipped with Timer ETM/Counter--- --------
❑
a Pump installed in ❑1Suuc_ke_t1 or ® On Block or ❑ Other
o Pump Make/Model 1,t,�J t-V (mot M Floats or" 41 r ❑Transducer
C Tank draw down 2 o iNmin Pump capacity�
pm Squirt Height 15
ft
Pump on time I m:n Pump off time Iloo Daily flow set at 270 gpd
Mason County OSS Installation Report pg. 2 Parcel z
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - -- - - - - - -- ----- ® YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - ------- [a YES El NO
RECORD DRAWING
cola is a permarom..nJ aaa must M.ccunte ana Macrip4r.aneuoh b rHocah In u neW of malnarunw asM and M1Mn aarebornent T nk l Femea
a.nnss mnu� ouaselca mac:oie oienuaona.aew:.sed.c'odmc un.ao:an.No-nomm..nurn dalmaa.ea�soa and omdmm hwanee.aomnm«em.anue4nee.
na.ovena,a ;anc eaanwua-d elnema.numnce acceu cams. Incamae'a aewro oan�.va may wie ademonal delays�n rma:�rouer admo.alam mead aamu.
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APPR011E Se
FEB 15 207h
MASON COUNTY ENVIRONMENTAL HEALTP
JBW
Record Drawing Attache!
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER] ENGINEER
1 certify that 1 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 Reco
I i
Sig ature of Installer Date
JoG Hol>sC- �y
s
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
y sl tl 11. �
�s
The undersigned approves this Installation Report and p" �
Record Drawing on behalf of Mason County Public LICNars B33ED bESIci+CR "
H /th: �j E%IIRE3: 0l/22/�/fp
+�IUY'3". oa.a.5? 5
Signat re nvironmental Health Specialist Date (stamp,signature and date)
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLICVIEWONTHE MASON COUNTYWEB SITE uce.w e2irsm°
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