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Home My WebLink AboutSWG2025-00099 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG Ql\ie0.07- -0001g Parcel # 520Vg-51-0000r Applicant Name Sack; ' largtUet Petuon Subdivision (Name/Div/Block/Lot) Applicant Address t41?) SE-gm Ave, volt oQhwaf2&l 1(D1G% --a. R. City, State, Zip OAK H/LYCw,wA 6%111 Installer Name Shall M tplfh Site Address I52 W. LAKI Narwatze► fir. Designer Name N IA INSTALLATION CHECKLIST ❑ Full System Installation g Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type C-Sri Vt Pretreatment Type >5 ft. from foundation? - - ❑ N/A [J'YES ❑ NO >50 ft.from wells? - -- ❑ d ❑ Z >50 ft. from surface water? - - ElH Cleanout between building and tank? - - ElEl ❑ V Tank baffles present? ❑ a24" access risers over each compartment?- - ❑ [ ❑ W Effluent filter installed?- -- CIUf ❑ N Septic tank capacity (working) k 000 gal Manufacturer R,.01-h 5 D-box water level and speed levelers used? - - [f N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - Li mZ Check valves installed? - -- ❑ ❑ 0Q 2 Transport Line Size Schedule/Class 4 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 El 6 ❑Commercial/Other >10 ft. from foundation?- -- El N/A IA YES ❑ NO 4 0 >100 ft. from wells?- - ❑ , .,, 1 W >100 ft. from surface water? - - u. >10 ft.from potable water lines?- - ❑ 1I r g 1 Z > 5 ft. from property lines and easements?- - CI1 r �, 1 Q ,_._/ 1 IX > 30 ft.from downgradient curtain/foundation drains? - - ❑ lJ r v i Drainfield level and observation ports present - - ❑ ❑ rJ S 1 El Graveless chambers or ❑ Clean gravel used? (check one) NWA, �( _ !, Proper cover installed over drainfield?- - t�J ❑ o m Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tank capacity (flood) gal Manuf urer Q 24" access riser(s) and accessible fro urface?- - ❑ ❑ ❑ H n. Alarm or Control Panel Installed? - - ❑ CI 2 Control Panel equipped with Timer/ ETM /Cou - ❑ El ❑ d- Pump installed in ❑ Bucket or ❑ On BI k o ❑ Other d• Pump Make/Model ❑ Floats or ❑ Transducer a. a Tank draw down in/ ' Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated P/21,2018 Mason County OSS Installation Report pg. 2 Parcel# 62,008- ► 00009" ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - [o YES ❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - [A 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. Drarnfield&manifold orientation 8 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 and related permits. Record Drawing Attached CERTIFICATION OF INSTALLATION it 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. Signature of Installer Date ShM\G %A#tQt Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: ROVVYWC?Yll Health Specialist Date (stamp, signature and date) Signature of Environmentalp ( P 9 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updatec 8/21'2018 RECORD DRAWING (continued) 411 �s a ,� a Z .,* ) coirf•fa o • 1C f \4 vr 1/41 !t s -L c N.k_ vocc.a._,, ,, ,o,‘, .. cp. cot\soA ,..J iX lJ t, C" Q APPROVED JUN 0 6 2025 MASON COUNTY ENVIRONMENTAL HEALTH RET Pa. YCel t 6100g-S 00009-