HomeMy WebLinkAboutSWG2023-00029 - SWG As-Built - 6/9/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 202.3 - Oa)ZG Parcel # 3Z 03,T 7S (j(w
Applicant Name Jtlll l ll.OLgiUle Subdivision (Name/Div/Block/Lot) i
Applicant Address P6 c31tF?
City, State, Zip (Fill On LOPi gd-Rit/ Installer Name e a ra No:
Site Address Igo S' Ash A Designer Name ig(�c�rr, litinl-et-
INSTALLATION CHECKLIST
TTTT����0 Full System Installation ❑Tank(s)Only ElDrainfield Only ❑ Repair 0 Other
System Type et.SSu(c. Pretreatment Type #416 A/A-
>5 ft.from foundation? - �{ - 0 N/A YES ❑ NO
>50 ft. from wells? - U LC - 0 ❑
Z >50 ft. from surface water? - - - - - JUN �4 ��� 0 • ❑
FQ- Cleanout between building and tank? - - -- - - - -- ❑ 0
V Tank baffles present? - ❑ ❑
a24"access risers over each compartID---- - 0
W Effluent filter installed?-
Septic tank capacity(working) 1(LID gal Manufacturer R ae Brtil .(.(i ( cSVto(kez/1.P'1
S D-box water level and speed levelers used? - - ry(N/A ❑ YES ❑ NO
OO Manifold/D-box accessible from surface?- - E3 El El
' mZ Check valves installed? - - ❑ 0 ❑
oQ
2 Transport Line Size Z It Schedule/Class SCJi U b
Bedrooms installed (check one) ❑ 2 ❑ 3 [4t4 ❑ 5 126 0 Commercial/Other
>10 ft. from foundation?- - 0 N/A 71 YES ❑ NO
CI >100 ft. from wells?- - 0 CZ 0
W >100 ft. from surface water? - - 0 1 0
LT: ft. from potable water lines?- - ❑ 2 ❑
Z > 5 ft. from property lines and easements?- - El
a
CC > 30 ft.from downgradient curtain/foundation drains? - - El
o
Drainfield level and observation ports present - - ❑ ❑
0 Graveless chambers or g Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ V 0
Pump tank setbacks consistent with septic tank? - - ❑ N/A IV YES
❑ NO
• Pump tank capacity(flood) 2.00 gal Manufacturer 40Q, 674.1.4 ( 6(1J0t)
Z ❑ NI ❑
Q 24" access riser(s) and accessible from surface?- -
f-
a Alarm or Control Panel Installed? - - El53 0
2 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0
M
4. Pump installed in ❑ Bucket or CE1 On Block or ❑ Other
a Pump Make/Model L'rt,d, 29 O l Floats or 0 Transducer
E Tank draw down ( in/min Pump capacity 5 gpm Squirt Height ft
a
Pump on time 2 wt:n Pump off time yis evd Daily flow set at 27U gpd
Upda'ed 82'.2O'8
arr.
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES 2 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ 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 Grainfield 8 manifold orientation&layout.Sep;cdpump tank location.North arrow.reserve draintield.existing and proposed buildings.location of wells.waterlines
wells.observation ports.cieanouts,and other maintenance access points. Incomplete Record Drawings may create add,tional delays in final installation approval and related pern-ts
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 all State myself and Mason County Public Health and meet all
9 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 Dra ' • accurate.
Sig ature of Installer A Date ..••:Y w,,,r,,'••�`.
J,), !/
Printed Name of Signee °�
.. 51UOa1Z •N^
0`: ADAM J.HUNTER :�
MASON COUNTY PUBLIC HEALTH L'rrf`,t'NM11}t'cC`,!Jt-•V'
The undersigned approves this Installation Report and t-xl'd;ES 07,12/
Record Drawing on behalf of Mason County Public
Health:, N .5-V) (0 I
C 1-I
COW .
Z....c
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Jpdated 8,21 20•8
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