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HomeMy WebLinkAboutSWG2024-00407 - SWG As-Built - 8/25/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2,Q2 - O e) '1O 7 Parcel `� # Va- Gl4`\00(p 3 � �l,In Applicant Name L\ &CjVU \ vs (Name/Div/Block/Lot) Applicant Address 29\ . Zi eti(' _. City, State, Zip A k 1'i Installer Name0-L/11� i/� / "'/`�' Site Address \ CM.: t - Designer Name D©AVC_ VI41 n INSTALLATION CHECKLIST 6 Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other System Type.'CW 1 Pretreatment Type >5 ft. from foundation? - DisclitwE N/A YES ❑ No >50 ft. from wells? - ❑ Z• >50 ft. from surface water? 1111- G-Q 7 10 - 0 Cleanout between building and tank? - - - - - - 0 o Tank baffles present? - - [ 0 d24"access risers over each compartment?- - BY—_-- - C. ❑ N \t0 L Effluent filter installed?- - ❑ 0 le Septic tank size . gal Manufacturer `� t'\rtiNA� 9 D-box water level and speed levelers used? - - ❑ N/A E YES ❑ NO 00 Manifold/D-box accessible from surface?- - ❑ Ud ❑ mZ Check valves installed? - - 0 0 11 0'a \ i 1 Transport Line Size "� Schedule/Class Bedrooms installed (check one) 0 2 1713 0 4 ❑ 5 ❑6 0 Commercial/Other >10 ft, from foundation?- - ❑r1 NIA [� YES ❑ NO O >100 ft.from wells? R ft .1.. 0 W >100 ft. from surface water? - - - =�-�- 1 In ti >10 ft. from potable water lines? - — -AT — —— - I 0 'Try- Z > 5 ft.from property lines and easements? Auu 25 5 L ❑ ii > 30 ft. from downgradient curtain/foundation drialhO IZY-al\I1ROM E.NTAL ty,LT ❑ 0 Drainfield level and observation ports present - 'TI — — . 0El 0 CL7( Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ [] ❑ Pump tank setbacks 9 nsistant with septic tank? d N/A El YES El NO Y Pump tank size VI (A gal Manufacturer NIR Q 24" access riser(s) and accessible from surface?- e] 0 ❑ a.. Alarm or Control Panel Installed? - E211 ❑ ❑ 2 Control Panel equipped with Timer/ ETM/Counter- lU 0 0 \ . n- Pump installed in El Bucketor 0 On Block or 0 Other C' i k mPump Make/Model N i A ❑ Floats or 0 Transducer EL a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at qpd Upaatod 8n V2018 NW Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - CJ YES [] NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? • - ID YES [] NO RECORD DRAWING ThIs Is a permanent record end must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development Typical Record Drawing"contain: Drainfield b manifold orientation 6 layout.Septic/pump lank location,North arrow,reserve drolnfleld.existing and proposed buildings,location of wells.waterlines, wells,observation polls.cleanouls.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. A ?RovE MgSp 2025 N CCtarYENVI �B l MENTAL HEAL 7/-- 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 /further certify that all information contained on this f a attac ed cord Drawing is accurate. form and attached Record Drawing is accurate. Signature f Installer Date boo, 1 1—{e r+►,vt_j 'fl fnvi _ ,Printed ame of Signee ; f �_- 11 4 MASON COUNTY PUBLIC HEALTH • (*W V1 The undersigned approves this Installation Report and •J t �``•:'1 Record Drawing on behalf of Mason County Public �,�?`� ;� `'' .s:51 r. He( '`' t, ..,;ai, (..A)U 1�� 4t�S 25 Sign tur: vironmenta!Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updatedenlnole RECORD DRAWING (continued) a0 x o d m co m x r Z ► ��_ lid-/+,8££ _ r � '` RSp. . �7 7Or �lr � m Zl � i i -1' .1_1?`\\4401r A, z z z D T n D CC _,,,,Aki ZO A o o C IIIIII !iii / .V ' o I ® ii w '� z aocn 4 1 D O 0od8 ? oPROPOSED„, _0:-... 4 �' �'...1 :,,,D. 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