HomeMy WebLinkAboutAFTER THE FACT DRAWING - SWG As-Built - 4/15/2025 _ __ - HEALTH
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System 712e
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Pump Make/Ma:7;a'.i Tank draw ov..: _ ii _ . — _
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Mason County OSS Installation Report pg. 2
Farce, ?- 32° cCCCC-
ABANDONMENT RECORD
Were existing septic components abandoned as pan of this project? -
❑ YES NO
If yes, please describe:
Were ail components pumped out and properly abandoned per WAC246-272A-03C0? - ❑ 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
Dra'wingS contain. Ofainfield&manifold orientation&layout,Septicpump tank location.North arrow,reserve aratnhheld.6X3tinc and orcposed buildings.location of wells.waterlines,
wells.absorvauon ports,cleanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
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le Record 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 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 accuratee.—�- form and attached Record Drawing is accurate.
-4bs)O`er
Signal installer Dale
Printed Name of Signee •
MASON COUNTY PUBLIC HEALTH
The undersigned approves tnis Installation Report and
Record Drawing on behalf of Mason County Public
Health:
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 Updated 9.2t/2C 6
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STE 224-332
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