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Home My WebLink Aboutswg2025-00158 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG ZOZ5 - GO/ 5 S Parcel# 14ZZ!Z. — 5 / —Z 100 4i Applicant Name e/l-PPELL. Ur 1 T/'d5 Subdivision (Name/Div/Block/Lot) Applicant Address .f u/t S' 4,,.2 lU ' ib . '- City, State, Zip W..11NocrA ex9 63‘) Installer Name /'?oy Q/ /-/v7 - Site Address 5% A) 0 LLb i4 I c-L- t-i t LL Designer Name INSTALLATION CHECKLIST 0 Full System Installation pf-Tank(s)Only 0 Drainfield Only 0 Repair ❑Other System Type 6- R 4✓t .-t79 Pretreatment Type N D/V e >5 ft. from foundation? - - 0 N/A YES ❑ NO >50 ft. from wells? -StI El El• >50 ft. from surface water? - U El54. ❑ ill Cleanout between building and tank? ---10 -- 13 A '\ -1 - El IA El ✓ Tank baffles present? - 1% 0U� 0 - - - II en,. 0 IF- 24"access risers over each compartment?- ,AO. -' - i 0 N Effluent filter installed?- $V- Y� - ❑ 95. 0 Septic tank size /6'60 gal Manufacturer _DJ f-1LT2#/TO- t M /OHO 3 D-box water level and speed levelers used? - - rif N/A ❑ YES ❑ NO OO Manifold/D-box accessible from surface?- - 0 0 o0Z Check valves installed? - - ❑ ❑ 0< 2 Transport Line Size Schedule/Class Bedrooms installed (check one) i 2 0 3 ❑4 ❑ 5 ❑6 0 Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO 0 >100 ft. from wells?- - 0 0 0 W >100 ft. from surface water? - - ❑ 0 0 Z — >10 ft. from potable water lines?- - ❑ 0X `5/ri O Q > 5 ft. from property lines and easements?- - - - - - - - - - d > 30 ft. from downgradient curtain/foundation d dins? - - ❑ ❑ ❑ 0 Drainfield level and observation ports present - - ❑ 0 ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tank size gal Manufacturer Q 24"access riser(s)and accessible from surface?- - ❑ ❑ ❑ H a Alarm or Control Panel Installed? - - ❑ 0 0 2 Control Panel equipped with Timer/ETM/C me - -r------ - - - - 0 0 ❑ D 13- Pump installed in 0 Bucket or ❑ On lock or 0 Other a Pump Make/Model ❑ Floats or 0 Transducer 2 a. a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd updated 812112018 Mason County OSS Installation Report pg. 2 Parcel# 'T-1—Z-q7-51-71 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - OYES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - '> YES Ei 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 tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation pods,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. s-� t 4- n4-cff4c'/9 ,igRecord 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 c ify that all information contained on this i further certify that all information contained on this form d a a Record Drawing is accurate. form and attached Record Drawing is accurate. 2-5 Si a of InstallerDate ;te,72/ 47 Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: x(,, ..1—t livizicoin 1 t Signature of En'vimnm ntal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated em2018 Z{Z2fz - 5I- 2-(6o ° RECORD DRAWING (continued) L 2 o -`- 1 t I of I Q J 1 J "' t i 4- a 1 Q k) \ � I pp J 3 MASpN COUNn IV 6 ?025 6 R�RONMENtAI H Fl FAITH I