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HomeMy WebLinkAboutSWG2024-00315 - SWG As-Built - 8/25/2025 . Mason County OSS Installati.,.. Report pg. 1 MAb iN COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG o2- 21 00 3 I5 Parcel # 2,a ,015q 0Pb 2 1 Applicant Name StSC&f Mom S Subdivision (Name/Div/Block/Lot) Applicant Address d-( VE (,,„4i ) (coQ City, State, Zip -gel-.r cicep_ Installer Name ID nak1.c..A 00Yo nea tt jar n -, Site Address )-1 Nj Ly-.--•.-4) I -e Designer Name ,ji Nt Z.Mn,' / AM INSTALLATION CHECKLIST Full System Installation 0 Tank(s)Only ❑Drainfield Only ❑Repair 0 Other System Type ?c- S`,;__;r'c Pretreatment Type >5 ft.from foundation? - tlt ❑ N/A ®YES ❑ No >SOft.fromwells'? - {� � ❑ ® 0 Z >50 ft.from surface water? - �t� - ❑ © ❑ < Cleanout between building and tank? - -AUG © 0 ✓ Tank baffles present? • A11 O 4 Z ❑ ❑ d ID access risers over each compartm•nt?- - - - - - - - - - - - 0 2 W Effluent filter installed?• By - ❑ LA Septic tank capacity(working) IC GC) gal Manufacturer Pc.Hn 0 D-box water level and speed levelers used? - - - - 2 N/A ❑ YES ❑ NO OO Manifold/D-box accessible from surface?- - 00 ❑ mZ Check valves installed? • - © ❑ ❑ 0< E Transport Line Size Schedule/Class Bedrooms installed(check one) �] 2 0 3 ❑4 ❑ 5 ❑6 0 Commercial/Other >10 ft.from foundation?- - ❑ N/A ❑ YES ,L] NO Ci >100 ft. from wells?- ,t - 0 ® ❑ W >100 ft. from surface water?- ;.1'4 - - 0- ','5.'c © ❑ LL >10 ft.from potable water lines?- ,� ® 0 .erZ >5 ft.from property lines and easements?- - . - - -AUG 2-� �01f� ® 0 >30 ft. from downgradient curtain/foundation;rQnti��?COUNTYENV!ROd,^- El ® ❑ 0 Drainfield level and observation ports present - HEALTH Et ❑ ® Graveless chambers or ❑ Clean gravel used? (checJB Proper cover installed over drainfield?- - ❑ J] 0 Pump tank setbacks consistent with septic tank?- - - - - - ❑ NIA ig YES ❑ NO Ne Pump tank capacity(flood)- CIt.Q __gal Manufacturer gO4-L1 < 24"access riser(s)and accessible from surface?- - [t ❑ ❑ H a Alarm or Control Panel Installed? - © 0 ID 2 Control Panel equipped with Timer/ ETM/Counter- - El 0 ❑ D d Pump installed in ❑ Bucket or VI On Block or El Other a Pump Make/Model Lim 1`60 © Floats or ❑ Transducer Tank draw down in/min Pump capacity _gpm Squirt Height ft a rr -- — Pump on time Pump off time Daily flow set at 10o gpd l;?7ale1H:'1 T"it Mason County OSS Installati`._ Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - R YES 0 NO If yes, please describe: 'ce,ek-.� -k,_„� Were all components pumped`out and properly abandoned per WAC246-272A-0300? - - id YES 0 NO RECORD DRAWING This Is a permanent record and must be accurate and descriptive onough to re-locate in the need of maintenance activities and future development. Typ,cai Record C•aw,ngs contain Dra,nrisId&n endold o,entat.on&layo-t,Soot„ipur-p ta'k location.North arrow reserve drainfield existing and proposed bui'orgs,location of wells.waterlines. wells,otsar.atinn ports.NearcAs.and cider ma nlenanra accaSS pores Incomplete Record Drawings may create ad(hhonal delays In final instalaoon approval end related permits A f4S1NI 1?SC44 15 \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 er ertify that all in for 7ati contained on this I further certify that all information contained on this form id attach cord rawing 's accurate. lf form and attached Record Drawing is accurate. 1 ilS/ Z`I ignal of Installer Date lrl 3 rtt '(L• 0 N !•,I,• Printed Name of Signee St: �'4 :i'.`. •. Si MASON COUNTY PUBLIC HEALTH /y � s jel The undersigned approves this Installation Report and o? '. • ;� `e�.. LICE : s s SIG R Record Drawing on behalf of Mason County Public .... Ck\2 ••Vi .�. ;, H:iii �/ IF.•414/k CA 4t./ta. IZI'-- 2 1 Sig :to *"Fvironmenlal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upd'Nd 6/212°15 ../ IL e_ E O _• '�3 J 0_ E ��...-:V S r .' a 00 O cc, M E o Ni a., \\ 4, .fi l 4J C to _ v1 NI `0% 4sa cN 3 D v < _i 3COo ` Q, J h�� O � Q r V] Q < o N m Q) #k 0 0 0 cc w W "J U � 1-1 1 J Ln __I w w- . 0 .-4 • * w ,vz. a 4-► in ,tiE e a Z Z pri b£ 06 0 Q o _I � = pPRovA U w O � AUG oO °� 111 I MASON couNT , 2 2025 w U O 0 NT cNVIROni,,,, At yFAtT Z vv II Z � 8� N } I— p w Lu — N ~ X m O>C ,-1 w rJ in 24' Q Q ----4 . -\s.. 0 V* .... .0 y0 0Z ,�Z w u N °‘� N Ce Q U O `�` rn d W OQ O$f�`` �j�}�\\ a\ 1 N 1 I