HomeMy WebLinkAboutSWG2024-00219 - SWG As-Built - 6/26/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG ZO) G/ ..002 /'7 Parcel# 31cja�,2 j(f6:,o I
Applicant Name II.1),'S P ,111 Subdivision (Name/Div/Block/Lot)
Applicant Address /0t7/ SE- oi, ;b r
City, State, Zip S/',rj/ct-i 11JR. c/ ;,(32( Installer Name rjkA,�c .c1-1 LI
Site Address 1130 SF 4::re,,5 rd Designer Name Jcf.-,h Pau SSc!-1/
INSTALLATION CHECKLIST
'Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other
System Type S),‘J/a.v pre66 rc- Pretreatment Type
>5 ft. from foundation? - - ❑ N/A [ 'YES ❑ NO
>50 ft. from wells? - - ❑ R ❑
z >50 ft.from surface water? - - El ❑
ha- Cleanout between building and tank? - -- _ ❑ E ❑
o Tank baffles present? - - ❑ Er ❑
n~. 24"access risers over each compartment?- _ ❑ ISt El
tW Effluent filter installed?- ❑ N. ❑
Septic tank capacity(working) I s.C)(7) gal Manufacturer but-14 /c,e.twcHf--
CI D-box water level and speed levelers used? - - KI-N/A ❑ YES El NO
DLL
O Manifold/D-box accessible from surface?- - ❑ I f ❑
m— Check valves installed? ❑ ❑
6 Q
E Transport Line Size 2 �� Schedule/Class L/0
Bedrooms installed (check one) ❑ 2 E3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ N/A AYES ❑ NO
o
>100 ft. from wells? ❑ El ❑
^-1 >100 ft. from surface water? - - - - -- ❑ Et
W -
Z >10 ft.from potable water lines?- _ ❑ [g ❑
2 >5 ft.from property lines and easements?- - ❑ El El
> 30 ft.from downgradient curtain/foundation drains?- - ❑ ® ❑
CI
Drainfield level and observation ports present - - ❑ lEt ❑
[ t Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ •f ❑
Pump tank setbacks consistent with septic tank? Ill N/A `� YES ❑ No
Y Pump tank capacity(flood) ), 0 gal Manufacturer & )j yieveyv, y,/—
< 24"access risers)and accessible from surface?- - ❑ 1 ❑
O. Alarm or Control Panel Installed? - _ ❑ la ❑
E Control Panel equipped with Timer/ETM/Counter- - ❑ a ❑
d Pump installed in ❑ Bucket or IR'On Block or ❑ Other
2 Pump Make/Model ty 6,44-I W-Floats or ❑ Transducer
fl Tank draw down /, 7 ' in/min Pump capacity '-/2 gpm Squirt Height 4,..r. h ft
Pump on time 1M,h 3 5 Sec.- Pump off time S,'y )1Uvr-5 Daily flow set at •:?(Z) gpd
updated 8/21/2018
.1
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES 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: Drainfield&manifold orientation&layout,Septicipump lank location.North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
wells,observation pods,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
i
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
and Mason County Codes. State and Mason County Codes
I 1 further certify that all information contained on this 1 further certify that all information contained on this
i form and attach ecord awing is accurate. form and attached Record Drawing is accurate.
i �------ n`, 3-, 2 ll
Signature of Installer Date 1
1
Printed Name of Signee h ,.,. 1...
MASON COUNTY PUBLIC HEALTH 0.4r`
r. N „fe 22030834 r"ll
The undersigned approves this Installation Re o� JUSTIN a
t 9 PP P i� is N root{�ttt ' 1
I Record Drawing on behalf of Mason County Public • ss � i is't
Health:
c(m/7tCr 10
Signature of Environmental Health Specialist Date 'j',p s (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE12tR PbEkli VIEW ON THE MASON COUNTY WEB SITE Updated 8/212018
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