HomeMy WebLinkAboutSWG2023-00424 - SWG As-Built - 3/5/2025 Mason County OSS Installation Report=Address
g. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
er SWG - parcel -�( -Q7 inc.�
me Subdivision (Name/Div/Block/Lot)
ressip Installer Name
esigner Name
INSTALLATION CHECKLIST
13 Fun System Inatellehon ❑T nk(G)Only ❑Dralneeld Only ❑Repair ❑other
System Type Lp_ 3�,f4 Pretreatment Type
>5 ft,from foundation? -_____ _ �y n fa n.❑p I� I�
>50 ft.from wells? - __ IBC (V, fSUU/ 1L�7"{IlfiTi{VI'rIIII ❑PJA ®Yea ❑ ao
5g >50 ft.from surface wateYl ._ .____ _BAR Z ❑❑ m ❑
Cleanout between building and tank? . ❑
Tank baffles present? .--_-----_ -_„- __.--. ® ❑
24'access deers over each _ O ® ❑
NEffluent filter Instolled?----------------------- ❑ ® ❑
$Spfip tank capacity(working) IS- sal Manufacturer.
?Z� D-box water level and speed levelers used? ._____________ _ RWA ❑Yes ❑ NO
Q a ManlfokUD-box accessible from surface?._______________ , ❑ I ❑
Q4Z Check valves installed? .- ----- --- ---------------- ❑ ® ❑
i Transport Line Size -L' Schadule/Class Ll
Bedrooms Installed(check one) ❑2 103 ❑4 ❑5 ❑6 ❑Commeroiel(Other
-10ft.from foundation?-------------------------- ❑ M/A ®Yea ❑ NO
>100 ft.from wens?----- ------------------ ❑ ® ❑
W >100 ft.from surface water?.-_____________________ . ❑ ❑
Sp >10ft.from potable water lines?--- - ----------------- ❑ ❑
d >5 ft.from property lines and easements?-____ ® ❑
>30 ft,from downgradiant curtaln/fo,raill on drains?._---_-__ . ❑
Drainfield level and observation ports present -----
❑ Groveless chambers or 10 Clean gravel used? (check one) ❑ ® El
Proper cover installed over dreinfield?-- ------ -- --- ---- -. ❑ ® ❑
Pump tank setbacks consistent with septic tank?- - -- - ---- ___ . ❑ NIA ® yea ❑ No
= Pump tank Capacity(flood)j Sbc) oat Manufacturer !Of, lift-of
F24"access needs)and accesslbie from surface?- - - -- -- - - _ __- ❑ ® ❑
y Alarm or Control Panel Installed? ------ - -- ------ --- -- - ❑ ® ❑
s Control Panel equipped with Timer/ETM/Counter---- - -- -- ❑ ® ❑
Pump Installed in ❑ Bucket or ® On Block or ❑ Other_
1L Pump Make/Modal _ 3 j Z. rl4f [a Floats or ❑ Transducer
R Tank draw down-�, �In/min Pump ospacity . '� apm Squirt Height �pt
Pump onbma L nn,r•., . Pump oil time Dolly Aowsetat pd
uyawm+m+e
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENTRECORD
Were ems"ng septic components abandoned as If Yes,please describe: pan of this projaIX7
-- ------------- ❑ YES ❑ NO
Were all components pumped out and properly abandoned per WAC248-272A.0300? ----- - -- YES ❑ NO
RECORD DRAWING
Tel•I••n.men•m nverx w mun s•.•wwm raw a•ananv.vevnn Iv m.laua F m.v..a•r mam•ravw anxu••.m ww..awm emWvo.wwF. areFnxas ew.,rtoF va.nallv4 sle wmv u��.mulrov.uamcmmr,,•••„,pxml.F ev°u. mwvm. TYwulRrare
I"'smua Y•�a vrwv,etl wnmtlpem nvv vl,r,n•wclerr�a
•r•.•.eh•M'•Ikn p°N,tlY�W1R•nd xlelm•Fhlncxe,mau ptinll Inwrngq R•vOrtl DAWre,meY r/•.b MNilMel pel•y In MY In,uuwan caporal aN rw'eb°p•enld.
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIONERI ENGINEER
/eantly that I installed the system in accordance with I Gadfly that the system has been Installed in ,Wr-
the septic design stamped"APPROVED'by Mason dance with the septic design Sfampad'APPROVED-by
County Public Health and that any deviations shown Meson Counfy Public Health and that any Oaaabons
here have been cleamd/approv6d by both the designer shown hem have been cearad/approved by both
and Meson County Public Health and meet a//State myself and Mason County Public Health and meet all
and Mason County Code,. State and Mason County Codes
I further cartlfy,that all information contelnad on this I further cerdlly,that all information contained on this
lomt sn attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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SI�Lp�n�e'tyu�reo nnsialalllerr Deb
Printed Nso fS'-'--Y4Q�
MASON COUNTY PUBLIC HEALTI* `R✓ r'
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The undersigned approves this inafellaf�a Rop '
Record Drawing on behalf of Macon Co-u Crr(+}'.P.ubhe 06, wv.di°R'Ln'.ese
Hea�alltth/{�/// -„fy
ri ME /�� �pyAPo��t 1s O Stgnetu m froamenfel Health SpeciWat Date y (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUB` NEW ON THEMASONCWNTY WEB SITE Lbe•uenma+•
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MAR 0 6 2025 ♦ `
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NASCN COUNTY ENVIRONMENTAL HEALTH ♦
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