HomeMy WebLinkAboutSWG2023-00277 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2,023-0Qf23j Parcel #L(20 -*4- 00010
Applicant Name paw vortical Subdivision (Name/Div/Block/Lot)
Applicant Address PQ 12O)( 1dj l E 31l'of W Ij2'of N Iy0'of S '11 N'IZ SE GE
City, State, Zip GheitOn, wA cig6g4 Installer Name Shunt WIpleS
Site Address Ill 1N RASti& LP. Designer Name NIA
INSTALLATION CHECKLIST
❑ Full System Installation q] Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type Gifl VIh4 Pretreatment Type
>5 ft. from foundation? - - ❑ N/A 0❑YES ❑ NO
>50 ft. from wells? ❑ Fll ❑
>50 ft.from surface water? - ❑ g ❑
Z
HCleanout between building and tank? - _ CI El' CIV Tank baffles present? - ❑ ❑
a24"access risers over each compartment?- _ ❑ ❑
`W Effluent filter installed? CI [1 El
Septic tank capacity (working) 1 (?)43 gal Manufacturer Pit j Lr P1Gtiti( .
0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO
xO Manifold/D-box accessible from surface?- - ❑ CI CI
m— CI CICheck valves installed? - ❑
OQ
E Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑ 3 0 4 ❑ 5 ❑6 I ❑Commercial/Other
>10 ft. from foundation?- IkA IC)UtW ) ❑ N/A ❑ YES ❑ NO
>100 ft. from wells? ❑ ❑ ❑
W >100 ft. from surface water? - _ ❑ CI C:
a
LT >10 ft. from potable water lines?- _ ❑ ❑ ❑
IM
Z > 5 ft. from property lines and easements?- - ❑ CI CIo
Q N
Q > 30 ft. from downgradient curtain/foundation drains? - - ❑ CI CI c=3 cj
Drainfield level and observation ports present - - ❑ ❑ ❑ [M o
❑ Graveless chambers or ❑ Clean gravel used? (check one)
EProper cover installed over drainfield?- - CI ❑
L m
Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES El NO
Y Pump tank capacity(flood) gal M. ufacturer
Z
< 24"access riser(s)and accessible fro surface?- - - ❑ ❑ ❑
I—
Q. Alarm or Control Panel Installed? - - ❑ ❑ ❑
2 Control Panel equipped with Timer/ETM/ e ter- - ❑ ❑ El
m
n- Pump installed in ❑ Bucket or ❑ 0- Bloc' or ❑ Other
a PumpMake/Model
� ❑ Floats or ❑ Transducer
dTank draw down in/ in Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updatec 8/21'2018
Mason County OSS Installation Report pg. 2 Parcel# 42tZ2'Lig OM 0
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 121 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: Drainfield&manifold orientation&layout,Septic/pump lank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
g Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that 1 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
for�ttached Record Drawing is accurate. form and attached Record Drawing is accurate.
5101
Signature of installer Date
than Map es
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
R \oA, r\
Signature of Environmental H alth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8!21!2018
RECORD DRAWING (continued)
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APPROVED
JUN 0 6 2025
MASON COUNTY ENVIRONMENTAL HEALTH
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