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HomeMy WebLinkAboutSWG2025-00017 - SWG As-Built - 6/9/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH ` APPLICANT/ PERMIT INFORMATION Permit Number SwG 2625 - b U n Parcel # S ZWOy—Uu- 6(1>laC1 Applicant Name �\c A,4.A.,r, Subdivision (Name:Div!BlockiLot) Applicant Address 1;) , i66\4, I ea City, State. Z; WChC, i(Ala%S l Installer Name 46o -t. 6a A-tr, Site Address TLC �lb�hd CAJ J Designer Name - G.t t Hon f-U- INSTALLATION CHECKLIST _, I-•_.a a: - ❑ E ❑ Dranfieid ni; ❑Repair ❑O:^.er . System Type 1 Fret- . ent Type >5 ft.from foundation? ❑ wit VYES 0 Na >50 ft.from wells? . V\ - - III ❑ Z >50 ft.from surface water? - 't `5- ' 0 Cleanout between building and tank? -- - VA. Al , 11 ID U Tank baffles present? n,. - - - II 0 ii a24"access risers over each compartment? B9- - - IPIR - - - 0 0 W Effluent filter installed?- 0 ❑ N Septic tank capacity (working; 1S k \0 b' cal Manufacturer V-\_( Pre efA4}- o D-box water level and speed levelers usec2 0 NA 0 Yes ❑ No XO0 Manifold/D-box accessible from surface?- - ❑ ❑ ❑ m Z Check valves installed? - - ❑ 0 0 L¢ `� uD a Transport Line Size Schedule'Cla Bedrooms installed(check one) ❑ 2 103 ❑4 7 " El6 ❑Commercial/Other >10 ft.from foundation? � - -- ❑ RA' YES 0 NO 0 >100 ft.from wells?- - - 0 0 - >100 ft.from surface water?- - 0 ❑ ILI >10 ft.from potable water lines?- - 0 0 Z Tr >5 ft.from property lines and easements?- ❑ 0 ix >30 ft.from dowrtgradient curtain/foundation drains?- - 0 0 Drainfield level and observation ports present - - 0 0 0 Craveless chambers or 'Clear gravel used? (check one: 0 Proper cover installed over dramafield?- - ❑ Funnp;anfi setoacks consistent with septic lank? - " N,A VS YES 0 NO 1 Pump tank capacity (flood) `c-0.... cal Manufacturer �.U cre,C.CAIS‘c" Z 24"-access riser(s)and accessible from s r:ace?- - ❑ EZD 0 1- 0 Alarm or Control Panel Installed? - E Control Panel equipped with Timer 1 ETM/Counter- ❑ 0 n- Pump installed in 0 Bucket `or On Block or 0 Other__ -- a Pump Make/Mode; (.)..b-e( ci0 -ioaa or 0 k ranstucer a=. Tank draw down 2_' 1(m__inimin Pump capacity c( __ •'- _ Height C `.. Pump on time !.V - Pump off time lI Daily flow set at_3'60 _ gp ,' xx ek2'.2:•A 1 Mason County OSS Installation Report pa. 2 =- �- ABANDONMEN T RECORD t Were existing septic components abandoned as Mari of ties project' - • i YES Q NC • If yes, please describe - _ _ _— Were all components pumped out and property abandoned per WAC246-272A-03007 - - 0 YES ❑ NO RECORD DRAWING -•S s a;.arra =r.:ett = a c .a:cc ac_..-a:e an.ce>:•-..e enough:a .....:a in the nee:.;I-., :e.ar=e ao t ei :,ees and future deeoD•:nert. -,.. Fit---'" D•a,.:,ps te -a:,: Oranlseed&t arvdold orientation&tayou: s:::Vaulty)nnk location.North arrow reserve era ens.leaving and proposed bu16•nps.bca::-c''he.a.na:_• moo,observation aa's.creamer art otter marrkr+a see access rooms. kiccenpk:e Re-�D•re ngs may creale at_•s-a c a,•c -a -sta;:a°'ax• :. a -e a:et re-- Is 0 Se:c d Draw;Attache: CERTIFICATION OF INSTALLATION INSTALLER DESIGNER; ENGINEER 1 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 cleareo/approved by both and Mason County Public Health and meet ell 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 wing is accurate. Mature of ns aPe' is `l 3 f Zt' rr:rtea r sme ciS;gre- �'•'i `i 4= �... '',� MASON COUNTY PUBLIC HEALTH Diu Yt, The unders:gnec approves this installation Report and 5191$3f2 -'•4 O.' ADAM,1.NYN Record Drawing on behaif of Mason County Public IME'n(t1',t3w:ofe., I=f7r-' Health. I q I D' I IS— 6ZIIKES o7,I_.. SR)\sli\illi . 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