HomeMy WebLinkAboutSWG2024-00126 - SWG As-Built - 5/22/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number. SWG 24121-1 "OO !Zb Parcel # 2 2/Z9-- 52 -D coo
Applicant Name MegISS4 '1-�t.e k.rd1/4,rt Subdivision (Name/Div/Block/Lot)
Applicant Address .330 e. 67 nr15 t. a4j
City, State, Zip Sr►et / A 18�P�`f Installer Name 1Mfos( c 2r PAtiz Ate-
Y Site Address 33D E • u?aer is 636Ya Designer Name Ct✓ y W
INSTALLATION CHECKLIST
(Full System Instaliatun 0 Tank(s)Only - ❑ Drainfield n.y ❑Repair ElOthe
System Type2' (Z Covet ii Pretreatment Type 0l,r
>5 ft.from foundation? - - - - - n N/A f.YES ❑ NO
>50 ft. from wells? - - - - - hn •�+ f ❑ Pi ❑
Z >50 ft. from surface water? - ,,.�--�� _ �� lyq ❑
HCleanout between building and tank? - - I- ., i�7-S- - - _- ._ _ ❑ i % ❑
V Tank baffles present? �''� _ 5 _ ,�
d24'access risers over each compartment64 tl- MAY 12�� , 0 f ❑rg ❑
N Effluent filter installed?• :`l'_ _ - _ 0
Septic tank capacity(working)• -o0 a%;::,:er S+'S
--....1D-box water level and speed levelers used? - •- ----- -- - - •• .• - . - . '1,/A ❑ YES [) NO
>CO Manifold/D-box accessible from surface?• - - - - - - - _ -- - -. . - • - . K ❑
Ga Ecz Check valves installed? _ _ _ _ _y ❑
to 1031.
2 Transport Line Size Z Schedule Clasz 40
Bedrooms installed (check on.3) 2(2 L,,. _;4 _, 5 0 6 ❑Commercial/'.Other
>10 ft. from foundation? - -• _ _ _ _ _ _ _ _ _ .. _ _. u N/A . YES ❑ NO
0 >100 ft. from wells? - - - - •- -_ -, PS- 0
W >100 ft. from surface wale..? _ _ _ _ 0ti >10 ft. from potable water lines?- •. . r,1 ar �❑
xQ >5 ft.from property Ines and easements?• ? ElQ >30 ft, from downgradient curtain/foundation dril.�s% -- - • - • - . i
❑ 0
Drainfield level ar.o observation ports aresen: - -• - - -=- - -•- _•- • _ - rl A ❑
0 Graveless chambers or f Clean ^ravel ? (check v 7c
Proper cover installed over drainfiela? _ .. .. _ ._ _ _ _ . 0 e . 0
Pump tank setbacks consistent with septic tank? • `rM ;ti N/A ,*YES ❑ NO
Y Pump tank capacity(flood) l l .pa' ManLfactur r SO( __
Z
< 24"access riser(s)and accessible fro surface? - - - - - - -• •• .. .. - - - ...
_ 0
O. Alarm or Control Panel Installed? - - - - - - - •- - - - - - - -. - - - - . J ❑
Control Panel equipped with Timer 1 ETM/Counter- - - -- -- - - - - - - 0 I
ri
a Pump installed in 77❑ Bucket__ or , On BIo;.L: c- ❑ Cter
a' Pump Make/Model 's2 Ni— l 2 ,
2 s� Floats or 0 Transducer
n- Tank draw down _ in/min Pum capacity yy cpm Squirt Height 7 ft
Pump on time I K1 I V\ - ump o P f time je 1-'� 6 Daily flow set at21"lO gpd
1 �pCs:r._'S� 5
Mason County OSS Installation Report pg. 2 °arcel 221 L1^ 52- O
ABANDONMENT RECORD
. Were existing septic comp;:ne-its a.andcauc as �a,: ,.. . , p•D,ect% - - - - - - - ,'YES 0 NO
• If yes, please desditie: ptt
IN pal Q� cot p1-4C I Pt pike•
Were all components pumped out and'properly abandoned per WAC246-272A-0300? rielES 0 NO
• RECORD DRAWING
Thls is$permanent record and must be accurate and descriptive enougn to re-locate In tno need Of maintenanosactivitios and future development. Typical Record
Drawings contain: Dra nt:eId&manifold w,entaoo:,&layout.Sena pump UM,location.NoMn arrow,reserve dratrfeld.erstirg and proposed bua:mngs.iocatcn of wets watemnes,
wells.observatio"pans,cles?cuts and otter man:enands acce!e p 's. I• 'nrplote:Zeuad D.ae 6:k,s:.1:;:',.lt•.1::c:'icna:Mays ..f:,at insat:at:on approve:and related permits.
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0 Record Drawing Attached
CERTIFICATION OF INSTALLATION --
INSTALLER t .. S:3rL Fu,i.NC: :iZ
i
I certify that I installed the system in accordance Mitt; 1 •cr:':,;•::i:. tl,t>s s•: ;::;c been installed in accor-
the septic design stamped'APPROVED" y Mason 1 car:ce :v:t!,rnt: ..., .. ;.esign stamped'APPROVED"by
County Public Health and that any ceviatiorts show:, ::fus:.1 :::.a.:r.; ?7 Health and that any deviations
here have been cieared,•aH;;oved by both the desir;,a- f --hct,'e;he ;: .'.a;e:Jeer!c/eared/approved by both...-
and Mason County Puclic Health an,::meet a/i Stare i rit.scbf ono Mason C ourry Public Health and meet ail ..
and Mason County Codes. 1 Stare end Msaon County Codes
1 I further certify that all inforrna;ior: contaire.r: , :°a '.`s:rt:?er certify that al!information contained on this
i for nd attached Record:.,Va- ;ratr.s am! . ;c.r.'.' :is ai_;r;.•i,record Drawing is accurate.
1 -----e � ZZ21. -
j Signature of ins;ailer s ��- s.
- -_ _ - I
I Printed Name of Sig^ce i r, of tos ('
rs , q►'? YpR
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MASON COUNTY PUBLIC HEALTH • •
t.4
EThe undersigned approves this lnstailat,on Deport,:no' i e 5> >e 'I .
i •
Record Drawing on behalf of Masai County Publc LICENSED DESIGNER 1G.
Health: Vil .3''
" - �� �s� i a����t,_
Signature of Enviwa ae:::at r-- +:•' 3,seic:a;s.�y_ . i st af. t signature and date)
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