HomeMy WebLinkAboutSWG2025-00108 - SWG As-Built - 6/9/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION 1
.
Permit Number SING 202.j- - °p L O Parcel# .31.1 L -1 -S-Z- 0066 3
Applicant Name 146am filer Subdivision (Name;DiviBlock Lot l
Applicant Address 22,q 9,r 6- fie, SLR
City. State. Zip aympt.a_, ( if 9A.317, Installer Name 4lV, /2e&-'kij
Site Address (1) L f[ri9r"Lic (6 k k Designer Name g a am H. r�
INSTALLATION CHECKLIST
0 Fug System tnsle ❑Tank(s)Only 0 Ora `e!c On!; [2fRepair ❑Other
System Type (1 sccA,r XO 2., Pretreatment Type
>5 ft.from foundation? - - 0 NIA ( YES 0 NO
>50 ft.from wells? -
12ZWE ❑�� ❑ ( 3 ❑
Z >50 ft.from surface water? ❑
;5_ Cleanout between building and tank? - - iu tl-0-4 1.[}2G - - U ❑
V Tank baffles present? - -/
❑ 0
P 24"access risers over each compartme. ; - - - ❑ ❑
o_ By 1 j
tt1 Effluent filter installed?- - - - ❑ ❑
Septic tank capacity(working) (1,00 gal Manufacturer L4 QceC f
D-box water level and speed levelers ::sec p - ❑ WA 0 YES ❑ NO
)<C ManifoldlD-box accessible frcm surface?- - 0 0 0
t 12¢ Check valves installed? - ❑ ❑ ❑
a Transport Line S'ze Schedule/Class
Bedrooms installed (check one) ❑ 2 (D3 ❑4 0 5 0 6 0 Commercial Other
>10 ft.from foundation?- 0 NIA 50 YES ❑ NO
C >100 ft.from wells?- - 0 ❑
W >100 ft.from surface water? - - 0 V ❑
ti >10 ft.from potable water fines?- • 0 Q ❑
Z >5 ft.from property lines and easements?- - ❑ 4 ❑
Q
tY >30 ft.from downgradient curtain/foundation drains% - - 0 !il ❑
C Drainfield level and observation ports present - - 0 W ❑
0 Graveless chambers or p Clean gravel used? (check one;
IPrope*cover installed over drainfield?- - ❑ ❑
Pump tank setbacks consistent with septic tank?- - `1❑n N:A ` YES 0 NO
Pump tank capacity(flood) 1 � gal Manufacture- ktb'5PR9.uiht _
z o V ❑
Q 24'access risers)and accessible from surface?-
a. Alarm or Control Panel installer? - - CI i►_t El
E Control Panel equipped with Timer/ETM i Counter- - ❑ g ❑
G
Q- Pump installed in 0 Bucket or )On Block or 0 Other
c- Pump MakeIMOdes a-ex\l±b Floats or 0 Transducer
1 G Tank draw dowr �l inimin Pump capacity m Squirt Height )1�
�
Pump on tirre Z Q T.x.rn,Pump off time NYCil c . `SrCar% Daily flow set at 3(Qt> c^^
Mason County OSS Installation Report pg. 2 =
1 ABANDONMENT RECORD
I ere existing septic cc- -:s abandoned as pan of tnis project? •-- - - - - -- - - - - -• YES 0 NC
If yes. please describe: - _ _ _ _
Were all components pumped out and properly abandoned per WAC246-272A papa? - I,(kYES 0 NC
•
RECORD DRAWING
714 is a ern`a-en:reccr:and',us:t:e ae:.:rate and descr:etire enough to re-locate i:- t-t need et maintenance sctivi.es and:Mire development. Ty,..J Recctc
17'2vetr'.g,s coMan' Dracr�.+''s-r a '. _ . _- _ _-S ?.: Se::_._:..":Wit battiOn.Nat'l arrow reserve drairtheld.eAa5ng and irr::::sad told,reas.bcatzel of amis.1
slerines
._ s .._,_..Da-,X!S c•-..> _ . :a-a-__ ___. . __ -e.e Recce.....C-avringt r^ay as*ad eaial delays in riim:4;103'an 111)V0vi art related permits.
0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
I 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 l further certify that all information contained on this
fora - id attached Record Drawing is accurate. form and attached Record Drawing is accurate.
6/2
attu a c;irsra\iler i.. A/
�I� j- S i1-,
36t J�C. i� .. .�tt
Printed Name of S c o,.`F'•,+ "',,,,,'•-,%.
MASON COUNTY PUBLIC HEALTH of • tl'_ •' Ji_/
The undersigned approves this Installation Report and r›�`.s• J ....\a•
pp �� 5100412 �.
Record Drawing on behalf of Mason County Public f ADAM J.HUNTER �f
Health: ����� t���� .�.��
PrN2AlYy��r� ! i I _ `l�S tnlEs ogler 2Signature of Environments n.ai.n Speciaist Date
(stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR=,,o�,:,VIEW ON THE MASON COUNTY WEE SITE .;;Cate'
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