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Home My WebLink AboutSWG2023-00485 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWGZen-00tf8ri Parcel # 320Im-et-02001 Applicant Name ''(arm( ►deKex Subdivision (Name/Div/Block/Lot) Applicant Address crie E D&41iu5 Qd. (,fdou' Eirovt✓i#2 0(14. 2 hot,1- City, State, Zip cheltOYI, W A qg5$+-1 Installer Name shy& i1c pes Site Address Daniels Rd Designer Name NIA INSTALLATION CHECKLIST ❑ Full System Installation dTank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type elYGI Vti-'I Pretreatment Type >5 ft. from foundation? - - ❑ N/A ['YES ❑ NO >50 ft.from wells? - -- ❑ !' ❑ Z >50 ft.from surface water? - - ❑ Me ❑ FCleanout between building and tank? - - ❑ ❑ U Tank baffles present? - - ❑ u ❑ d24"access risers over each compartment?- - El (g ❑ W Effluent filter installed?- -- ❑ I! ❑ co Septic tank capacity (working) too gal Manufacturer PY&rn iXr PIAStiGS 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - ❑ ❑ ❑ u. op-2 Check valves installed? - -- ❑ ❑ ❑ OQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 1 ❑Commercial/Other >10 ft. from foundation?- - - - - t 1�C --_- - - _`❑ N/A ElYES El NO C >100 ft. from wells?- ■ •r.-s- W >100 ft. from surface water? ❑ ❑ ,.0 t EL >10 ft. from potable water lines?- ❑ ❑ �� N Z 5> ft.from property lines and easements?- - ❑ ❑ tri `" 0 > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ ittti �, i Drainfield level and observation ports present - - ❑ ❑ Ft z 1 ❑ Graveless chambers or ❑ Clean gravel used? (check one) le1 Proper cover installed over drainfield?- - ❑ ❑ m.1 m Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO Pump tank capacity (flood) gal Manufacturer < 24"access riser(s)and accessible from surfa ?- - ❑ ❑ ❑ H a Alarm or Control Panel Installed? - — ❑ ❑ ❑ 2 Control Panel equipped with Timer/ ETM /Counter - - ❑ ❑ ❑ D a. Pump installed in ❑ Bucket or ❑ On Block r Other a Pump Make/Model ❑ Floats or ❑ Transducer a. a Tank draw down in/min Pu p capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updatec 8,21,2018 t Mason County OSS Installation Report pg. 2 Parcel # 7i2,010- 1- 02001 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - d YES El NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 4 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: Drainfiold&manifold orientation&layout.Septic/pump tank 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 ano related permits. dRecord 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 accurate. form and attached Record Drawing is accurate. 51Iiu Signature of Installer Date Shaun Ma-p►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: Q\-Nay eie L( 6(5 Signature of Environm ftal Health 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) Parccl #`32010-61- new (P1.uoIi( warn system AP pROV ECG MASON COUNUN 06 2025 Car nE �iROhM&ITALHEALT Port RET New 1300 gallon PruniCy Plastictanic insanolocation V +� e A House E. ootni els Rd• _ _ _