HomeMy WebLinkAboutSWG2024-00112 - SWG As-Built - 6/9/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number S'.7G 2('Lk-1- Ohl 11- Parcel # (9,19 Y0 -710- OU 11 0
Applicant Name mN,(-, IM-754\11 Subdivision (NameiDiv.'Block Lot)
Applicant Address 9 b l&- 1.,0
City. State. Zip t -i&C-ell0,1,A biro qt d"LYS") Installer Name 1) {. bl .
Site Address LZ7 0 LO Cv\lilV tAcy\.1 Designer Name A6 CUV-\ tAUr j
INSTALLATION CHECKLIST
'- ii Fu l System 1
lnstaila:one� 0 Tank(s)Only ❑ Dra ❑infieid Only 0 Repair Other
System Type c>GJ\(b � \ ..N(� Pretreatment Type
>5 ft.from foundation? - - ❑ N'A 0 YES ❑ NO
>50 ft. from wells? - ? N5 D}L, }�1 (�� ❑
Z
>50 ft. from surface water !Ir.) 1��i� ti` ❑
Q Cleanout between building and tank? •• - - - tlZ. 17i S s- -- ❑
-All' ,,
U Tank baffles present? - - - - - ] 0
l••' 24-access risers over.each compartment? - - - - - - - ❑
W Effluent filter installed?- —` _______ . 0 ❑
co
Septic tank capacity (working; /)-0 ea! Manufacturer t-A-a Pam)i-
ll o D-box water level and speed levelers usec? - El N'A El YES 0 NO
X0 Manifold!D-box accessible from surface?- - ❑ 0 ❑
oQ Check valves installed? - - El El El
2 Transport Line Size 2-v (\ Schedule/Class D
Bedrooms installed (check one) ❑ 2 ri6D3 ❑4 ❑ 5 ❑o ❑Commercial'Other
>10 ft. from foundation?- - ❑ NIA IV YES 0 NO
CI >100 ft. from wells? - - ❑ ❑
W >100 ft.from surface water? - - ❑ ❑
u. >10 ft. from potable water lines?- - ❑ ❑
Z > 5 ft.from property ' ?- - ❑ ❑
Q lines and easements?
0 > 30 ft.from dormgradient curtain/foundation drains? - - ❑ ❑
Drainfield level and observation ports present - • ❑ tP 0
0 Graveless chambers or 0 Clean Gravel used? ;check one �'
Proper cover installed over drainfield?- - ❑ P ❑
Pump tank setbacks consistent with septic tank? - - 0 NIA 4 YES ❑ NO
`-L Pump tank capacity(flood) ) 1, Gal Manufacturer Lka Pre/1 o1-
cf Z ❑ l El
access riserisi and accessible from surface?- -
4. Alarm or Control Panel Installer? - - ❑ (� ❑
2 Control Panel equipped with Timer ; ETA1 Counter- - 0 V 0
n- Pump installed in ucket or ( On Block or 0 Other
n- Pump Make/Model 1 .1y Floats or ❑ Transducer
2 r
2 Tank draw down 1 , I l) ,n/min Pump capac t'. 1f,1•' gpm Squirt Height ` -r ft
Pump on time -I, Yh,rN, Pump off time 1' x\-. Daily flow set at k(i) gpd
Mason County OSS Installation Report pg. 2 Pace
ABANDONMENT RECORD
Were existing septic components abandcneo as ,:art ^i :n s oie_:% • - ❑ YES ❑ NO
It yes ;:ease describe:
Were all components pur-ped out and properly abandoned per WAC246-272A-0300% - - ❑ YES ❑ NO
RECORD DRAWING
7,:s,s a permanent recc•d and—at be acc.,ra:e and cesc,.cJca anoog.`.:o ra:ocato i^the need cf rna:ntenance activities any f......e ae:e:opT.e^t. �.: -.._.•.
.__ ..._- -,i ; ::-.--:-.'a :-3 _ _c:.' _•] ,:_ _ _•• .c.1-e a_ _,s:-;a' - _ -_ _ E.
0 Record 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 ar: State nyself 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 1 further certify that all information contained cn this
form a d attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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gate s f
Sic re of;rs a. 0
-'.hied Name o. S;ggree /co:li �t
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and i`,'a s,004,2 .•csAf1
Record Drawing on behalf of Mason County Public or i Q • .ADAM J.HUNTER :% 1'
GA
Health:
f� (� /' I 4 l' r
tr.,�t,.Es 0;;12;
I '' 1A-
Signature ofEnvironmenTa �?Health Specialist Cate (stamp, signature and date)
THIS =ORM MAY BE SCANNED AND AVAILABLE FOR PLBLIC VIEW ON THE MASON COUNTY V EE SITE :iodated&212cr.
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