HomeMy WebLinkAboutSWG2024-00326 - SWG As-Built - 5/7/2025 Mason'County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2)9•A f-- 0t 3o24) Parcel # LI ( 3) ? OSto
Applicant Name Be--vt. Po/44-4- Subdivision (Name/Div/Block/Lot)
Applicant Address 4'?, 131. -rfre-c( d y `t 7
City, State, Zip l( Installer Name 4 -Ac-q v Skop
Site Address )-3?70 US /twy ID( Designer Name /1-Pftn- /41/ier1. _
INSTALLATION CHECKLIST
7 Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair ❑Other
System Type 'TA11,9 1 Rerkit, —D$C44-2- Xo Pretreatment Type /i-4. 0 6,2
>5 ft.from foundation? - --- [] N/A g YES 0 NO
>50 ft.from wells? - �- - - -
-
❑ 0
>50 ft. from surface water? - 5� - - - - 0 0
Z
H Cleanout between building and tank D --�ia,- , - ❑ ►:4 0
U Tank baffles present? - -PQ- - - i - . - ❑ fg3 0
d24"access risers over each compartmen ,- - - ❑ 0
W Effluent filter installed?- �� 0 )i. 0
Septic tank size 10(00 gal ��f anufacturer Both (��� ' )
c3 D-box water level and speed levelers used? - - XN/A ❑ YES ❑ NO
o4 Manifold/D-box accessible from surface?- - 0 A 0
c9g Check valves installed? - - 0 ❑
1,(
Transport Line Size Q-!y I PYC Schedule/Class s4-1. Ct 0
Bedrooms installed (check one) 0 3 ❑4 0 5 ❑6 0 Commercial/Other
>10 ft. from foundation?- - ❑ N/A YES ❑ NO
0 >100 ft.from wells?- - 0 21 0
W >100 ft. from surface water? - - 0 ❑ EI
u„ >10 ft. from potable water lines?- - 0 til0
Z .> 5 ft. from property lines and easements?- - 0 0
02 > 30 ft. from downgradient curtain/foundation drains? - - ❑ ®, ❑
ca
Drainfield level and observation ports present - - 7-71 0 Ed El
❑ Graveless chambers or 0 Clean gravel us �c ec orfil
Proper cover installed over drainfield?- - 0 X 0
Pump tank setbacks consistant with septic tank?- - 0 N/A ,, 'YES 0 NO
ZPump tank size 10(oD gal Manufacturer Rolil
< 24"access riser(s)and accessible from surface?- - 0 Rt0
o. Alarm or Control Panel Installed? - - 0 M. 0
2 Control Panel equipped with Timer/ETM/Counter- - El ;i El;
i1 Pump installed in ❑ Bucket or frZC2n Block or 0 Other
CL Pump Make/Model '' I �
It4tOoj, ,p c)-)~0,SU o)-- 1/ 4p. .QFloats or 0 Transducer
per., Tank draw down i 10 in/min Pump capacity gpm Squirt Height 6S€44-4-- ft
Pump on time 1- 3D 5e,, Pump off time 3 M.r',v Daily flow set at ?-1/6 qpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - RYES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record
Drawings contain: Drainfleld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfieid,existing and proposed buildings,location of wells,waterlines,
wells,observation pods,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays In final Irrstafa:lon approval and related permits.
pk\-Aiivv;ve
061
ecord 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 C unty Code State and Mason County Codes
I further certi that all inf matt contained on this I further certify that all information contained on this
form and at hed Rec r r g is accurate. form and attached Record Drawing is accurate.
Signature nstaller Date
6-6�jU�i l P 'iz— �.. r-�
•
Printed Name of Signee I
1-1•Lr"
MASON COUNTY PUBLIC HEALTH ` :
•
The undersigned approves this Installation Report and P"
Record Drawing on behalf of Mason County Publicke
Health: = ` f
ADM.)J.HUNTER
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 Updsted 8121/2018
I09't
m
T
0
. NWy10/
Ti
z
li ''''''''.- -------- : ------ 4 I IIIILI'l***tlIllarearsso isio..
.,:,
y OR X02
_.
,„ ,
A___-
'a.
°F 40„ pit
N
N
� ' ,�� ?c ' ••WM
llip1,
-a
x1
BUU( ••DN _r -{28't A o
_ m O 3 z N Z Z
m
f1 m m
HO -
Dz 0 8$ N -
r Li
o I0
O : C z r ' Y�*+ D
z T T 0n -0 c *m m
D V d N m > q$
m D z u
r O o o > Kt o
5
~ O r O ? co
1 In m O o
O A 0
y S
D Q
_
L
W
C
L
K
r'
t-
qt
0
Z
t
(fir
C
C
•
m 4
w D
O
N Z D 0 0 (� 13 y
n p o x C p m Z
o 1 Z D v,-3 N 1. O O X < X CO c�
m _ 1=J (n c
m CA
`2 3 m z m m E r.'.:
z c D --I-I o i% Aillibs
Tyy))r vim"j 'Alt�\%�-
p (� _fi x, a .•�y�
l 1 r A �,I'•d
m ram— AWL"'
M N
N T to Z n CO C cri
i m -i z O
I
m D -12 z
O 0 r
m c ,. -1 D o Y
8