HomeMy WebLinkAboutSWG2025-00124 - SWG Application / Design - 4/8/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
eM. •: BELFAIR:360-275-4467,EXT 400
✓= Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00124 L 6v '
APPLICANT ROY ANN M Phone:
Address: 43 SPRING CREEK CT KALISPELL, MT 59901
OWNER ROY ANN M Phone:
Address: 43 SPRING CREEK CT KALISPELL, MT 59901
SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: 211 E PENZANCE RD
Primary Parcel Number: 321275100117
Permit Description: Non-conforming Repair 2bd pressure trench
Permit Submitted Date: 04/08/2025
Permit Issued Date: 05/19/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/01/2026 (based on date of inspection)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Drain field installation not to exceed designed upslope and downslope depth specified on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
DATE RECEIVED: /
MASON COUNTY H (/ V a
I I. COMMUNITY SERVICES AMOUN RECEIVED: RECEIVED BY: co N
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Public Health(Community Health/Environmental Health)
360427.9670.ext.400 or 360-275.4467.ext.400 0
415 N.6th Street-Shelton,WA 98584 S W G 5 Q
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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APPLICANT PHONE m m
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ANN ROY 253-620-0986 z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3
43 SPRING CREEK CT KALISPELL MT 59901 m
SITE ADDRESS•STREET.CITY,ZIP CODE x).
211 E PENZANCE RD SHELTON WA 98584 I w
NAME OF DESIGNER PHONE I N
CINDY WAITE 360-701-0205
NAME OF INSTALLER PHONE 0
TBD <
PERMIT TYPE(select one) DRINKING WATER SOURCE N I N)
M-RESIDENTIAL OSS COMMUNITY OSS JCOMMERCIAL OSS ff PRIVATE INDIVIDUAL WELL ff PRIVATE TWO-PARTY WELL Z
Mr PUBLIC WATER SYSTEM LAKE LIMERICK WS
TYPE OF WORK(select one) I
b"NEW CONSTRUCTION/UPGRADES REPAIR I REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR I °1
SUBMITTALS{MI 0 SURFACING SEWAGE EXISTING FAILURE ❑ SHORELINE CO
IT DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r I —1
OAPPLICABLE) 2 75'X150' ° '
WAIVERS (IF x I
0
DIRECTIONS TO SITE AND SITE CONDITIONS'(ex locked gate)
TAKE ST ANDREWS DR ENTRANCE TO LAKE LIMERICK, TURN LEFT ON PENZNCE I o
RD, PARCEL IS ON THE LEFT SIDE OF THE ROAD, SOIL LOGS ARE IN THE BACK OF o
THE RESIDENCE -
I —
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS t CONDITIONS
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SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 1 2 7 — 5 1 — 0 0 1 1 7
A design will be reviewed when 3 copies of each of the following are submitted:
0 Completed design form that has been signed and dated. 0 Scaled layout sketch, including all applicable items on checklist
Scaled plot plan, including all applicable items on checklist. 0 Cross-section sketch, including all applicable items on checklist.
This form may be scanned and available for public view on the Mason County Web site.Maximum paper size: 1I"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG �0 fir. op ay Designer's Name: CINDY WAITE
Applicant's Name: ANN ROY Designer's Phone Number: 360-701-0205
Mailing Address: 43 SPRINGS CREEK CT Designer's Address: 80 E PICKERINTG LANE
KALISPELL MT 59901 SHELTON WA 98584
City State Zip City State Zip
j DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑ Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
❑ Gravity 0 Pressure 0 Trench ❑ Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class SCHEDULE 40
Daily Flow: Operating Capacity 180 gpd Length 34 ft
Daily Flow: Design Flow 240 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1060 INFILITRATOR gal Number ,;: - 4
r•A. 9 ft
Receiving Soil Type(1-6) 4 Separation N_ A4J
Receiving Soil Appl. Rate .6 gpd/ft2 di; Orifices
' ,
Required Primary Area 408 ft2 Total Number '!')r , • `• 'A . 28
f.
Designed Primary Area 400 ft2 Diameter ,~' t y Id %0 3/16 in
Designed Reserve Area 400 ft2 Spacing `` nit 41 4— 60 in
Trench/Bed Width 3 ft r ' ucCI Ep D D Ac aniifi<1
Trench/Bed Length 136 ft Sch=;eta we;w...v.w� • .vo.Q:,0 EDULE 40
EXPIRES 05,1a
Elevation Measurements Length 1-2 ft
Original Drainfield Arca Slope <1 % Diameter 2 in
New Slope, If Altered % Preferred manifold configuration used? ❑ Yes 0 No
Depth of Excavation Up-slope 14 in Transport Pipe
from Original Grade Down slope 14 in Schedule/Class SCHEDULE 40
Designed Vertical Separation 12 in Length 5 ft
Gravelless Chambers Required? 0 Yes 0 No ('Optional Diameter 2 in
Pump Required? 66 Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Diff. in Elevation Between Pump&Uppermost Orifice 6 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 2 ft Chamber Capacity(flood) INFILTRATOR 1060 gal
Uppermost Orifice ElfHigher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head 16.52 gpm 19ffimer l 'Elapse Meter 1,'Event Counter
Calculated Total Pressure Head 8.025 ft If Timer: Pump on ,Pump off
Comments
IF NEW DRAINFIELD GOES OVER THE TOP OF EXISTING FAILED DRAINFIELD, FILL WITH C-33
SAND, PUMP CONTROLS TO BE SET AT TIME OF INSTALLAITON
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 1 2 7 -- 5 1 -- 0 0 1 1 7
Permit Number: SWG _21 -cfa/2y
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
it Test hole locations 64 Drainfield orientation and layout Reference depth from original grade:
g Soil logs 0 Trench/bed dimensions and lid Septic tank
RI Property lines critical distances within layout Q( Drainfield cover
❑ Existing and proposed wells lif D-Box/Valve box locations Reference depth from original grade
within 100 ft of property lif Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks, and locations
52( Laterals, trench/bed, top and
surface water and critical areas 6t( Observation port location bottom
❑ Location and orientation of lii Clean-out location 0 Curtain drain collector
curtain drain and all absorption RI Manifold placement 0 Sand augmentation
components lid Orifice placement Other cross-section detail:
0 Location and dimension of 6iS Observation lif Lateral placement with distance ports/clean-outs
primary system and reserve area to edge of bed
It Buildings Other Information
121 Audible/visual alarm referenced Yes No
fifl Direction of slope indicator
lid Scale of drawing shown on scale cif ❑ Design staked out
Iii Waterlines bar 0 0 Recorded Notices attached
Pi Roads, easements,driveways, 0 0 Waiver(s)attached
parking 0 0 Pump curve attached
!i2 North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified y installerZ.:../
at time of installation Eg Yes 0 No
(11
S/fa /2r
Signature olDesigner Date ` 2r
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and local on-site regulations:
clf\QA/()NecorYi clkqmr--
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. c Jj
) 2
✓ The Onsite Sewage Permit has not expired, the Permit Expiration Date is:
V Drainfield site conditions have not been altered to adversely affect conditions of design approval.
Please Note: The system must be installed by a certified installer,
unless prior authorization is obtained from Mason County Public Health.
An Installation Fee is required.
This form may be scanned and available for public view on the Mason County Web site.
Updated Date: 12/7/2015
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ORIFICE SPACING 5
Lateral# Length Length Orifice # Distance from Distance from end Length#
# (Feet) (Inches) Spacing" Orifices feeder line of end of lateral
1 34 408 60 7 2 2 34
2 34 408 60 7 2 2 34
3 34 408, 60 7 2 2 34
4 34 408 60 7 2 2 34
136 28 135
TRANS LENGTH 5
GPM 16.52
K (2" SCHEDULEN 40) 284.5
FRICTION LOSS 0.0258367
Squirt 2
Elevation difference 6
TDH 8.0258367
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APPROVED ,417 N-y ��
MAY 19 2025
I,ASON COUNT EENVIRON (..).-
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MENTAL HEA °� ucEi LICENSED o40
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APPROVED
MAY 19 2025 +$
MASON COUNTY ENVIRONMENTAL N' _ s`-i
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XI=CLEANOUT/OBS PORTS (`a ��y a,'- 4V�+� 2{
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X3=Check Valves (1) T iv p u y- 1...; 4-p 0I.. 1CINOY0E4WAITE -* dh, :�
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APPROVED
MAY 19 2025
MASON COUNTY ENVIRONMENTAL HEALTH
RET
THREADED CAP OR PLUG
P r"- IIQu i-1- 6"PVC
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INFILTRATOR - L-. 1 aw IM-1060
septic tanks
Foam&serer
. I r2` C.v et., • Strong Injection molded polypropylene
construction
G tr`� ' i I 1 • Lightweight plastic construction and
+aAik- Iii\ inboard lifting lugs allow for easy
, 71'
_� delivery and handling
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I • Integral heavy-duty green lids that
1 ' ' lI ! interconnect with TWTl" risers and pipe
riser solutions
KKKKKKaKritirii s`' rt rr of sit E[ 77. MIMI Mg rAtt R .E;i q ;.i I'', , • Structurally reinforced access ports
eliminate distortion during installation
and pump-outs
'1 • Reinforced structural ribbing and
fiberglass bulkheads offer additional
strength
• Can be installed with 6"to 48"
of cover
The Infiltrator IM-1060 is a lightweight strong and dural?le septic tank. • Can be pumped dry during
This watertight tank design is offered with Infiltrator's line of custom-fit pump-outs
risers and heavy-duty lids. Infiltrator injection molded t nks provide a • Suitable for use as a septic tank, pump
revolutionary improvement in plastic septic tank desig , offering long-term tank, or rainwater(non-potable)tank
exceptional strength and watertightness. • No special water filling requirements
Inlet Side are necessary
• The tank may be backfilled with suitable
TANK CUTAWAY ® InfiltratorRise - i native soil.See installation instructions
r for guidance.
Rise
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MAY 19 2025 -
MASON COUNTY ENVIRONME , 1,1
Partition RET `•
baffle wale HEAVY DUTY LID
A CUTAWAY
.! reinforced
"structural
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I Plrotectl the Environment with Innovative*deviator .atment 8olutio :
__. �._T water technologies
IM-1060 General Specifications and Illustrations
LIFTING STRAP LIFTING LUG 1---
�RISER CONNECTION
(TYPICAL) (4TOTAU / (TYPICAL)
The IM-1060 Is an injection molded two piece'mid-seam iliroiref.e--*o—T:?-tri-Trl ^��plastic tank.The IM-1060 injection molded plastic design ,, llI II I 0�i�,
.pla. rloIgo ^-�'A
allows for a mid-seam joint that has precise dimensions A ;r=� ,� 1 1 t I ►, r•e; A
for accepting an engineered EPDM gasket. Infiltrator's t !;: a °o •'-�."� t B
gasket design utilizes technology from the water industry 4.... ' — ,:g .a; °o'���_-, 612
1151101
to deliver proven means of maintaining a watertight seal. ,... ,, I I L, `e';' EXTERIOR
11� �)� .P ��:i.. WIDTH
The two-piece design is permanently fastened using a !>��,v�� 1,, -I
series of non-corrosive plastic alignment dowels andTii
API(re J••. • • • �Ci! �IF�'
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locking seam clips.The IM-1060 is assembled and sold
through a network of certified Infiltrator distributors. 127.0 I32261 EXTERIOR LENGTH
Must be backfilled and installed in accordance with TOP VIEW
Infiltrator Water Technologies, Infiltrator IM-Serles Septic QUTLET
Tank General Installation Instructions and for shallow ! -
ground water conditions reference the Infiltrator IM-
Series Tank Buoyancy Control Guidance. / . 1\\
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Please visit www.infiltratorwater.com/images/pdf/ ;- _ - -- -__ __ _ (13491
ManualsGuides/TANK01.pdf for the latest information. 4111111- �� HEIGHT
5CLIP(TYPIM-1060UFTING ' ' ``.-,. - -..--/
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Working Capacity 1094 gal(4141 L) rTM
Total Capacity 1287 gal(4872 L) END VIEW
Airspace 16.5%
Length 127"(3226 mm) 04I1021 e24lel01 ACCESS OPENINGS WITH LOIN NGUDSt2)
PVCINLETTEE -10.2 fats)FREEBOARD 0411021 PVC OR
Width 62.2"(1580 mm) �I A�oTEE
Length-to-Width Ratio 2.3 to 1 l INLET _,J- 16 SM
1 , i I 4F CE p AIR SPA OUTLET
Height 54.7"(1389 mm) lie lid! P
COPE CODE
Liquid Level 44"(111 mm) 44.a 1—
FlBERG.ASS nhtp FIBEAG)ASS
Invert Drop 3"(76 ) suPPoar MUD �--5 SORT
(TYPICAU i DEPTH BAFFLE
Fiberglass Supports 2 WALLWIT
WQUIteD E
Compartments 1 or 1.'� ,
Maximum Burial Depth 48"(1219 mm) SIDE VIEW
Minimum Burial Depth 6"(152 mm) •
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Maximum PippQlairtgt�rq 6"(152 mm) CONTINUOUS
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Weight 0 Ibs(145 kg) 44' r HALF GASKET
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MASON COUNTY
EhV1RON:4!ENTAL HEALTH %`'�� ct ° �
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�Fr e LICENSEID ' ER Qw� HALFN BOTTOM /. k P.V
4 Winne Park Road ;" C/Il
Old SaP.O. ybrook,CT 06476 768 Lxc RtrS 0 10
INFILTRATOR' 860-577-7000•Fax eta-677-7001 MlC -HEIGHT SEAM SECTION
1400-221.443a
water technologies www.infiltratorawater.com
I
U.S.Patents:4,759,661;5,017,041;5,156,488;5,336,017;5.401,116;5,401,459;5,511,903;5,718,163;5,588,778;5,839,844 Canadian Patents:ti,329,959;2,004,584 Other patents pending.lnfitrator,Equalizer,
Ou)ck4,and SldeWinder are registered trademarks of Infiltrator Water Technologies.Inlltrator Is a regis Bred trademark In France.Infiltrator Water Technologies is a registered trademark in Mexico.
Contour,MloroLeactling,PolyTuff,Olsen ber3pacer,MuttiPort,POSILOGh,QuIckCut,Watley,SnapLock and StraigrrtLock are trademarks of In Itrator Water Technologies.
PolyLok is a trademark of PolyLok,Inc.TUF-ME is a registered trademark of TUF-TITE,INC.Ultra-Rib is a trademark of IPEX Inc.
C 2018 Infiltrator Water Techno!og!es,LLC.Al rights reserved.Printed In U.S.A. 1 IM02 1118
Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436
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Pump Specifications
250-Series Submersible .; %>>.
Sump / Effluent Pump '-
LITERS PER MINUTE
0 20 40 60 80 100 120 140 160 180
25 i —i I I t -4 i 1 1
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MAY 19 2025
MASON COUNTY ENVIRONMENTAL f
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0 10 20 30 40 50
GALLONS PER MINUTE
250 PI RI/17/2018 CCopyright 2018 Liberty Pumps Inc. All rights rescrsed. Spccitications subject to change without notice. Blif
Pumps
Installation Notes
Pressure Distribution System
211 E Penzance Rd 32127-51-00117
1. The prepared site plan is not a survey. It's the owner's responsibility to verify property
lines, utility lines (water, sewer, power, phone and gas) prior to installation.
2. Gravel base drainfield required
3. The tank may be moved as necessary to accommodate building requirements. Septic tank
location must meet all required setbacks.
4. Keep wheeled vehicles off the drainfield area before, during and after installation. Tracked
equipment only,
5. All ground, surface water and roof drains must be diverted away from the septic tanks and
drainfield. Ensure the final grade slopes away from these areas and water doesn't collect
on or around them. Use swales, berms, catch basin and tight lines, curtain drains, etc. to
divert all waters.
6. Curtain drains can be no closer than 10' upgradient and 30' down gradient of the drainfield
7. Exposed restrictive layers, cuts, banks, etc. can be no closer than 50' downhill from the
drainfield.
8. Install access risers on the septic tanks, valve box and ends of laterals.
9. Install observation ports at the beginning of each lateral and observation port and clean
out at the ends of each lateral.
10. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank.
11. Lids must form a water and gas tight seal with the access risers
12. Install effluent filter specified in this design at the septic tank outlet.
13. This system must be installed by a Mason County Certified installer.
14. Deviation from this design without prior approval from the designer and Mason County
Health Department will make this design null and void.
15. This design was sized per Washington Administrative CodeWAC246-272A-0230. The
operating capacity is based on 45 gallons per day per capita with two persons per
bedroom. The minimum design flow per bedroom per day is the operating capacity of
ninety gallons multiplied by 1.33. This results in a minimum design flow of one hundred
twenty gallons per day. This creates a surge factor of 33% but anticipated flow is ninety
gallons per bedroom per day.
16. Install laterals with contour of the ground
17. Install trench bottoms level and always maintain a minimum of six inches into native soil
18. Install locator tape on top of all drainfield laterals.
19. Install threaded clean outs at the ends of all laterals (caps must extend to within six inches
of finish grade and be in a valve box as shown on diagram.
20. Install audio/visual alarm A.
21. Filter fabric required over drain rock prior to backfilling. Ifj•e • fiin rock extends
above the original grade, run the filter fabric at least 2 in ' d fi the trench wall.
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APPROVED � yt`�''" �'�� Ll\tV
MAY 19 2025 dr!?LICCND V$AI E . 1P`.
MASON COUNTY ENV1RON�!ENTAL HEALTH „� ! tl00.-4;`4,
RET EA;'u ES 05/10,
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System Owner Responsibilities:
1. Operation and Maintenance is required by Washington State Department of Health and
Mason County Health Department.
2. The septic tank and pump tank should be pumped every three to five years or as
needed.
3. System owners are responsible for having maintenance performed annually.
4. System owners are responsible for responding to septic issues in a timely manner.
5. System owners shall not at any time change or alter settings in the control box.
6. System owner agrees to read and abide by information regarding their system in the
User Manual provided by Mason County Public Health.
7. Keep the flow of sewage at or below the approved design operating capacity.
8. Keep waste strength at residential waste strength parameters.
9. Spread loads of laundry through the week.
10. Do not use excessive bleach or detergents with added whiteners.
11. Do not shower, do laundry and dishwasher at the same time
12. Antibiotics can kill or impair the biological process in the septic tank.
13. Leaky plumbing can hydraulic overload your on-site septic system.
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APPROVED
MAY 19 2025 CIAO/
MASON COTI7 EN\/IRONYENTAL HEALTH
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