HomeMy WebLinkAboutSWG2024-00079 - SWG As-Built - 6/25/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2,0 Zit — 6 6 019 Parcel# 2 ZC1)Z - _ 1 S- 9'0d'-I 'a
Applicant Name trr.L I :sCe-r Subdivision (Name/Div/Block/Lot)
Applicant Address I O ec,hT f.,( 1 (%., L.-+ l L1Q -: ! I ;.z 1.r� I-Io 'Sf't"--e--- +'-`;,
City, State, Zip e,•G.c.i rr...... c.✓a. 1 VS-0-1 Installer Name _../4" ,//:-.--._ t'ieza<„
Site Address {'fc7 F'a-A.r 64f45w- L.Lt Designer Name
INSTALLATION CHECKLIST
ig Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type - .._P_retrPatment Type
>5 ft. from foundation? - U -C, ,-' - s l El N/A YES El NO
>50 ft. from wells? - - - ❑ 0 ❑
z >50 ft.from surface water? - _� JUN_Z Q /QM_ _£ ❑ 0. ❑
H Cleanout between building and tank? - -- - - ❑ II ❑
U Tank baffles present? - BY_- - ❑ 121 ❑
d 24"access risers over each compartment?- - 0 0 ❑
W Effluent filter installed?- - ❑ 0 0
co
Septic tank capacity(working) 1210c'1 gal Manufacturer j4`y ,e..-kvi,_ .4,-
O D-box water level and speed levelers used? - - e'N/A ES ElNO
O Manifold/D-box accessible from surface?- - - i1! Vi" ❑
Oti
CO Check valves installed? - - ❑ B' ❑
Q
E Transport Line Size 71 c c itS ule/Class (..t&
Bedrooms installed (check one) ❑ 2 Oa 3 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A 2 YES ❑ NO
❑ >100 ft. from wells?- - ❑ r' ❑
W >100 ft. from surface water? - - ❑ ET ❑
ti >10 ft.from potable water lines?- - ❑ ❑ ❑
ZQ > 5 ft. from property lines and easements?- - ❑ 0 0
> 30 ft. from downgradient curtain/foundation drains?- - ❑ H ❑
Drainfield level and observation ports present - - ❑ 0 ❑
iti Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ El ❑
Pump tank setbacks consistent with septic tank? - - ❑ NIA ,a.YES ❑ NO
Y Pump tank capacity (flood) r Z.Ot> gal Manufacturer l-lc... 5- vt_cam.,
< 24" access riser(s) and accessible from surface?- - ❑ 0
a Alarm or Control Panel Installed? El ❑
2 Control Panel equipped with Timer/ETM/Counter - ❑ ®ft- ❑
D III
a Pump installed in ❑ Bucket or 0 On Block or ❑ Other
a' Pump Make/Model /V I S'Z 0 .a() t t�` 19 Floats or ❑ Transducer
g L
a.a. Tank draw down 2. `lL in/min Pump capacity 60 gpm Squirt Height 3ft
Pump on time 1.33miN Pump off time 4HRS Daily flow set at "17$.0 gpd
Updated 8121/2018
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES ❑ NO
If yes, please describe:
Were ail components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑ NO
RECORD DRAWING
nos Is a permanent record and must be accurate and descripthre enough to relocate in the need of maintenance activities and future development Typical Record
Drawings contain: Drainfield&marifold orientation&layout.Septic/pump tank location,North arrow,reserve drairfield,existing and proposed buildings,location of wells,waterlines,
wets.observation ports.deanouls,and other maintenance access points- Incomplete Record Drawings may create additional delays In final installation approval and related permits.
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 further certify that all information contained on this I further certify that all information contained on this
form and tta ed Record Drawing is accurate. form and attached Record Drawing is accurate.
L6—S-7--ems'
Signatureof Installer Date
1 /
, (A,' K ,uc. I 6/20/25
Punted Name of Signee i°t► v''
Ar ►
iryj gAA..
MASON COUNTY PUBLIC HEALTH 4 �," ' 4► ,4
The undersigned approves this Installation Report and ��t. ►►
Record Drawing on behalf of Mason County Pr `� %' '�,'►�
Health: 'ASOA, ADA4 J.HUNTER ►,
)01,. ") 6/75/ ? °. •
91 r-7 26
Signature of Environmental Health Specialist Date e'"i 95
0. (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 821I2018
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