HomeMy WebLinkAboutSWG2024-00025 - SWG As-Built - 3/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
ES,"tlAddmes
SIG 2024-00025 Parcel# 22105-51-00002
FREEMAN REVOCABLE TRU87 Subdivision(kleme/DivlBlockAot)
as ID92651ST AVE SE _
State, _EVERtTT.WA 9n209 —__ Installer Name TRIPLE A
4090 E MASON LAKE DR W Designer Name CINDV WAITE
INSTALLATION CHECKLIST
■Ful System krts,l&Bm ❑Tank(&)Oey ❑Drakyyld Only ❑Repeh ❑now
Sydam Type_ _ PRESSURE DIST Pratreahrom Type SAND AUGMENTED
>5 ft from munaatwry7 ---__ ❑ ■���t
>50 a ir.;;,w„ia; - ❑ ■ Ci
_ >50ftfrorn w•h�..vaan ------------------------ ❑ ❑ ■
_F Cyanout betreea building and ank? -............ ❑ ■ ❑
Tank beffles preeem? -__________ _ - ❑ ❑
4 24'a ,f9 He9-fist rich Compartment? _- -U r;
rW EMuen!9Min.Paled?.__________________________ � `r.,
Septic tan' pr it:fvad;ing)Xt ,5 wl Manrdacturer
`J Dbo%Water eve!and speed lovden,used? -_-__ _____ l-r YaB
00 Manifaari.-cax omeealo;e from surfs,,?................
uMd
$a Checkvalvesinss:iec_ _________________ ❑ (--I
u
'd Transport i_ine ci>c 2 S,,etluleiClaee SCHEDULE 40
j Bedrooms insraned(meat one) ■2 ❑a ❑4 ❑5 [:IS ❑Cormlermgomar
y6 >loft from founda5on?S-------------- " ❑ ❑ No
>1DD ft from wens?--Aw6m._V--�+ft ladJr�tt
1 Mu• 1100ft from miat a2LY7-------------------------- ❑ Li ■
-1aR ft,,:r..e.lrl., .ree.ilnen%.__ . .___________ � � L.
I >5it from p,voeT lines and easements?.-....
-----'___' n Li
r >30 R.from downgradierd ourfelndoundabon drah s?.________. , I r
4 _ DraiMyW:eves and Observation Porte present---------____.
❑ Gravelass rd embers or IM Cyan gravel used? (&a*are) I
Proper mve•insmt.,never dramMld'+------------------- C A C
Pump tank seltrws"edent wim septic tgnk?-____________ Uhe, Gyo ■ �
2 Pump tank tnoad)X $O Q.i Manufacturer k�RrrE�.
24-aCCOWr.W(s)3n0 acceae;ae from surface?_____________ ❑ ■ ❑ f
G Alarm or Control Panel trataReA?-------______________ ❑ �, ❑
Controlacr.'� .,pay
Pump nslul. I1A.II* or ❑ CT Block or ❑ Otller
PUMP Makenv,utei x L12 2410 ❑Foray or L Transducer '.
G Tank drawaovm,)�J—jrvmin Pump capacity.1.41L27gpro Squirt Height A S R
Pump on ame suss Pump op ame DaiHfla.add 1e0 apd
w.r mmn
Mason County JSS inanllatlon Report pp.2 Pawele 2210551-00002
ABANDONMENTRECORD
Ware —firp awk Conpmreme"Wond a6 pan at this P,*W --------------- ■ M pMD
If yea,Pure desoft,
V4"21 mwurnc w:awc c.d and Pmp.ly awndw,ed pw wA W272amam-------- , M No
RECORD DRAWING �—
Mr•Fw�wt n.v:w:.nwrsur.iae.rM+�Tr,wea�rFrr>rrrrc..aw.warn ew+nrr M�+xme
harpaFrr nrrea^.rZaow:.iw:.raM1 MhVmrrbbt WNsm�.�rwrl�aaa reeFe•I F^S^T�.aa.r.+rrr. .
�.�.rr Pa Mn:_^..t1:M,._aFlnm�.0.'rh 'n:'nWeAn�tlDMNmYaF�MI�E�M.FIFYF4t.-'+i nprlrinr•]p�ML
Tack �u cal,.++ r1nJ.✓f�.
{4T7t +UflK-5 L4�� wn1lepl
Record Drawing Attached
CERTIFICATIO,,q OF INSTALLATION `
INSTALLER _ p DESIGNER/ENGINEER
I Mr*that I installed the system in accordence Mtn I Mr*that the system has been instwleo m act,,-
I the septic design.dnomd'A PPROVED'by Mevnn damn with the Who design stunned'APPROVED-bv
County Public Health and that aey devlaNals sboAr. Alasuu Courty Pulnlc Health and that anydevlatdns
here hero bean dMrad/ PMMd by both the designer shown ham ham been Clearedappromd by both
and Meson Count,Pubic Ih a/N and meat all Slate mysalf and Macon County Public r4mgh and meet It
and Mason Cmo"'i'x+s State and Meson County Codes
i/urtlmr ce.,ily in.,a..,.'kn"'aMon mntamed o:.d", I Mdner�Iry rant all monmedon ui U..0 on Nu
form an a' re 1 0 accumto. lonm an.anachea Record Drawing is ac almm.
63w
N/e Di mS'L.IJ.' DatO
Pdnded Name of Sryr;sa A
YtASON COUi:�:-:i.ELiC:;EALTIifie undersigned-pp,i':as this InsfeYalba Report antl
Record DMVWrc cn,9hrNn'Mason County Public
Health:
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SlRraan NEnvuwmmmel eaWSpedaeg Deco prab —— (stamp, srgneNm and date)
1 TWa.'.:%iM IMV aE 6gVINEDANDAWrWIa FOi %IeLIC vrEW ON TIE MASON COUNiY W£a artE u.r.vnnml
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APPROVED
= MAR 0 7 2025
T MASON COUNTY ENVIRONMENTAL HEALTH
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