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HomeMy WebLinkAboutSWG2025-00232 - SWG As-Built - 9/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION`L Permit Number SWG 72-`7-b0 2 Y? - Parcel # 7zZ �TZ/ 00 /63 Applicant Name AWA9-r /JO( ktA Subdivision (Name/Div/Block/Lot) Applicant Address 267 SCHa i r= S' . City, State, Zip LEVQ.FJ UJo927'/-f frVS . 60i3ZEInstaller Name A1-A./ /7/vJ A Site Address 'g© /J S ON C(-Q 5 J Designer Name UAJ iVo-'vi INSTALLATION CHECKLIST ❑ Full System Installation Tanks)Only ❑ Drainfield Only ❑ Repair 0 Other System Type r,,/ 111.-4 Pr- =tment Type OJON�_ >5 ft. from foundation? - ❑ NIA YES ❑ NO >50 ft. from wells? - a. , � -- • ❑ Z - )1" - - - ►\ ❑ >50 ft. from surface water? - Q Cleanout between building and tank? ---- - ---- - t` ❑ V Tank baffles present? - -S�e- (� � i tQ" ❑ v s Dom' d24"access risers over each compartment?--- --- - , - ❑ ❑ tW Effluent filter installed?- - - - 0 ElSeptic tank size 1ZSf..) gal nufacturer /-40051 5irn-16-t26 0 D-box water level and speed levelers used? - - N/A 0 YES ❑ NO >4Ou. Manifold/D-box accessible from surface?- --At=„1/4_ - ❑ ':£i3 Check valves installed? - - 2 Transport Line Size Schedule/Class WO KAhfl J f' Bedrooms installed (check one) 0 2 43 ❑4 ❑ 5 ❑6 0 Commercial/Other >10 ft. from foundation?- - ❑ N/A OYES ❑ NO CI >100 ft. from wells?- - ❑ V' ❑ W >100 ft. from surface water? - - ❑ VI 0 u. >10 ft. from potable water lines?- ici--14---- O. ❑ Z > 5 ft. from property lines and ease ts? ❑ ❑ a > 30 ft. from downgradie in/foundation drains?- - ❑ ❑ Drainfield level and observation ports present - - ❑ Ri 0 ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ti ❑ Pump tank setbacks consistant with septic tank?- - ❑ N/A 0 YES ❑ NO Pump tank size gal Manufacturer Q24"access riser(s)and accessible from surface?- - ❑ ❑ ❑ aAlarm or Control Panel Installed? - - - - --/- - 2 Control Panel equipped with Timer/E / bunter- El El El- a- Pump installed in 0 Bucket or ❑ On Block or 0 Other 2 Pump Make 1 ❑ Floats or 0 Transducer 0. Tank draw down in/min Pumpcapacity 0. Tank p ty qpm Squirt Height ft Pump on lime Pump off time Daily flow set at gpd Upda ed 821rz018 Mason County OSS Installation Report pg. 2 Parcel# )L{ z ABANDONMENT RECORD Were existing septic components abandoned as art of this ooject? - - YES NO If yes, please describe: C -6S H q.-") t.�tiVY Were all components pumped out and property abandoned per WAC246-272A-0300? - - L*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: Drainlield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buidings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. ftErRecord 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 l further certify that all information contained on this I further certify that all information contained on this form an ached cord Drawing is accurate. form and attached Record Drawing is accurate. �SZS Signatu f all r Date Print am of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: of qz('Lc Signature of Environment Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated8/21/2018 tt2211fL► uuiv ) ///,, RECORD DRAWING (continued) 1 N i i i fr i . Q1,, Y cilo w 1, sa / 151)tgiff 1\'‘ 9// L° o .' -$' APPROVED SEP 12 2025 • MASON COUNTY ENVIRONMENTAL HEALTH RET • Gci`l ., 1 ccca-1-/ci'L' TANK +4ep,N a)444, 9.,.i.1 C f vs 1.4 9 7 4-A/O (2-Q M00.4_.P . X, 10f go,i s c u cr-es-r--.0 2