HomeMy WebLinkAboutSWG2023-00220 - SWG As-Built - 3/21/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG )_O-)� - OO; ?ZQ Parcel
Applicant Name ..z a Subdivision (NamelDiv/Block/Lot)
Applicant Address
City. State. Zip P ,+ �( •� .ern 4dd66 Installer Name r) -• (e
Site Address = Designer Name T v.
INSTALLATION CHECKLIST
dFull SysMm Inslallakon ❑Tenkts)0my ❑Oralnl nld Only ❑Re-Pan ❑Other
System Type Pretreatment Types -roc
>5 h.from foundation? -- - - - - -- - - - - -- ---- - - --- --- ❑NIA ❑vES NO
>50h. from wells? . - - - - - - - - - - - -_ - - - -- - - - _ _ _ ❑ C7 ❑
Y. >Soa. from surface water? . _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ __ _ _ _ _. ❑ [� ❑
Clearrout between building and lank ❑
O Tank baffles present? - - - - - - - - - - - - -- - - - - -- - ----- ❑ 13, ❑
a24'access risers over each compartment?- - -- - - - - - - -- --" ❑ L� I❑1
W Effluent filler installed? - - - - - - - - - - -- - ❑ ❑
N
Septic tank capacity(working) /t5o t>al Manufacurer 1V^jgrmtiqL
,...,/ '✓ m
9 D-box water level and speed levelers used? --- -- - - -- - - -- - 13 wA ❑ yEs ❑ NO
OLL Manifold/D-box accessible from surface? - - -- - - - - - - - - - - - - ❑
IQ= Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - -' ❑ ❑
Transport Line Size
Schedule/Class
Bedrooms installed(check one) w 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - - - - - - AU ❑ NIA .(-7�✓yE6 ❑ NO
>100 fl, from wells? - - - - - - - - - - R u ❑
w >too ft.from surface water? - -- - - 71tLg Zl - 21 ❑
W >10 ft. from potable water lines?-- --- _ _ ---�- �-- L El-'
Z MQC9uNiYtt�,tilk(fryryl ❑
Q > 5 a.from property tines and eesem E7dTQ1-AEAL7 L!
O > 301t.from downgradlent curtainlfoundalion drainaFBW- - - -_- r� ❑
Oramfleld level and observation ports present - - - - - 13 ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used (check one) ry/ ❑
Proper cover installed over dramfleW- - - - - - - - ❑ emu./
Pump tank setbacks consistent with septic tank? - - - - - - - - -- - . ❑ WA G3 1Es ❑ No
Y Pump tank capacity (flood) 1100� � —gal Manufacturer I -
Z ?. _ _ _ _ _ _ _ _ _ _ _. ❑
Q 24-access risers)and accessible from surface ❑ ,--s� ❑
H Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - O
Q. ❑
f Control Panel equipped with Timer t ETM 1 Counter� - - - - - - - - -
Il Pump installed in ❑ Bucket or ❑ On Block or [y Other �`j,c, - —
Pump MakelModel_y_=-�'�. Lyrloals^ or ❑ Transducer
Tank draw down in/min Pump capacity gpm Squirt Height It
a Dail flow set at gpd
Pump on time Pump off time Y
Mason County OSS Installation Report pg. 2 Parcelp
ABANDONMENTRECORD
Were ex"I'o" seplic rompnnnnls ahandnnec as part of this prineW I - - - - -- - - -- ---- YES 2�NO
If yes, please describe
Wore all components pumped out and pmpeny abandonea per WAC246 272A-0000? - - - - - - -- ❑ YES ❑ NO
RECORD DRAWING
me M1.aYaa�«n nwe na..wr a xa.w.rw a..cdFlrx«ape w x+exlr m nw x.e a ..nr.eu ae MNp arY+ruwlync rye rr m
le~ ss4ro.+o rm+v aa�.wm«U..nx...m.w,rru.....aa.m wwxe ewa+v.wea,a.r..awn...
n[Y.ar.a.m�F'M1,�IM1.vq dries mxRau'N.YPY W^M1. ..aYYao RaoN pr.Yry.meY oxb tlLmfl EYM n IM n.reWYmi pP'aN iM Wb00a'^Y.
APPROVE
MAR Z 0 2025
MASON COUNTY ENVIRONMENTAL HEALTh'
JBW
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that f 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 Pubtic Health and that any deviations
here have been cleared/approved by both the designer shown here have been clearedlopproved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. Stale 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 wing is accurate.
I) // ✓ P-.�3 -�3
9gnature of Ins a&or Data
P P^
Pnntetl Name of Sig Pro~+^ �'�C�?i
MASON COUNTY PUBLIC HEALTH
the undersigned a g ppmves this Installation Report and 2 tni
Record Drawing on behalf of Mason County Public 22030829
R. Thomas Purdum
Hpnith: LICENSED DESIGNER
EXPIRES 2/07/2025
Signature o Enwonmentef Heath Specialist Date (stamp. signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ""^ "
c
M
i
o w O �►
u
w
o
o
D
-i N � r
O rn
3n Ob
3? MMm
m0 ^
nz
NN
NV��y
=pie�V
-a10p�yy �
nmV` �CyTy (pjm2 TOAO CC � �AIITA OAO3CCppDy .0i
m� GY, y3C3oTy y(ATN 33ND-1y OyOy- 33DD-V1 N
N n^ � 9Za ~3T A ~ TT 9T ZO,TM - -1ymm22�� Z
O n Z p❑p Z O T T T T T y T
OO m pZ UMT ? ym0 A2mAmm DmvwOO���m A
n3 m~ � 6xTm ME AZ TAO p2MM � OAOyTy - y2DNTNOOA D
p oA y OOD ODOS-D mDTn0�0 m2 TT
•3 0mz p SyZm TTT03g Or aim DD-S Z
MFN m ZZO- - ZOOia OyD�y mr��
3 D3D5 O OOA > M , pOA 4NT0 y
33yO ZZ OON3
(V o m m N m N C p Z 2 A O L1 a p y ao T
yA � NNbl3 � mOnCT VTN DGIn-<Zi
70 CO v cn A n a C AC A G=W Z�p �y mTm m m m g
D = n y;A m T N 2 A 2 y� p
YC m m Z8Z o' v 9wc ��D� s� 8� A
M M M yoy vvm OA = ua m y
Dom LOW ry'Zmo . Z p A
Z T Um DT 0 �t3i < A
C
O CO � 00� Am y3Z2p
T7 r mZ =i'i �� 3 O O Y
NA mm TZO 2 Z (Y£
`m zp � v
m =
N
C �F
NCil
O
.Z1 Z
Y`
8�
m> n-O0 m ` ��\ l
Dpr-r- m 1
Xm � � c- e
M;Q O i
m < b3 z \ti%
< 4— O
M Z ;a
m Z
z
v \
\F
� \ O
m 3 • \
a V. 4 \
m m FR \
o OMGo Ct \
tl �3
2��