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HomeMy WebLinkAboutSWG2024-00243 - SWG As-Built - 9/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 7..t - bu 1�3 Parcel # 1.(7,2tt.0- Et- a0t(.1 Applicant Name c v�.i camciM UY\ Subdivision (Name/Div/Block/Lot) Applicant Address 75ti„ . (Li . loc. Err. City, State, Zip t,.)tc,atu,c . AIL ciq 6rkA Installer Name )K /J 4 .tr Site Address 131 CO ClmcilAiwn lJ&& Designer Name r 1'l{-tom INSTALLATION CHECKLIST 5Tull System Installation Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type bvt't atment Type >5 ft. from foundation? - tAll-\\ � ❑ N/A ix YES ❑ NO >50 ft. from wells? ❑ N ❑ Z >50 ft.from surface water? - - - u��-p�-T�5 - 0 0 0 Q Cleanout between building and tank? - - --`- - - - - 1,71 U Tank baffles present? - �` - - - El El 24"access risers over each compartment? By.- - Tom► - ❑ Igli ❑ I �0 Effluent filter installed?- 0 n IN Septic tank capacity(working) tecr gal Manufacturer k iditeld V. 5 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface? - ❑ ❑ ❑ mZ Check valves installed? - - ❑ ❑ ❑ oQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 5d 2 ❑3 ❑4 ❑ 5 QI 6 ❑Commercial/Other >10 ft.from foundation?- I ❑ N/A ® YES ❑ NO >100 ft. from wells?- - ❑ M ❑ W >100 ft. from surface water? - - ❑ 4 ❑ ti >10 ft.from potable water lines?- - ❑ lij ❑ Z > 5 ft. from property lines and easements?- - ❑ IF:1 0 cc > 30 ft.from downgradient curtain/foundation drains? - - ❑ M ❑ • Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or la-Clean gravel used? (check one) Proper cover installed over drainfield?- Pump tank setbacks consistent with septic tank? - - ❑�nN/A (� YES El NO CCo.D• Pump tank capacity(flood) 106c) gal Manufacturer Paccul11- < 24"access riser(s)and accessible from surface?- - 0 [g ❑ H a Alarm or Control Panel Installed? - - ❑ © ❑ Control Panel equipped with Timer/ ETM/Counter- - ❑ 0 ❑ n- Pump installed in ❑ Bucket or isi On Block or ❑ Other CL Pump Make/Model `a eXk-1Gil Floats or ❑ Transducer a Tank draw down 1 in/min Pump capacity _-Ctl gpm Squirt Height `; ft Pump on time 2 Pump off time L/ . Daily flow set at -VNO gpd Updated 821,2018 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 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 relocate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septiupump tank location.North arrow.reserve drainfield.existing and proposed buildings.location of wells.waterlines. wells,observation ports,cleanouts.and other maintenance access points. Incomplete Record Drawings may create addd onal delays in final installation approval and related perrr.:ts. ❑ 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 form and attached Record Drawing is accuprate. form and attached Record Drawing is accurate. ii._,An szrAAAJI---.. I-Ikt-C .0 it ' :- ra Sig tune of Installer Date I Val Printed Name of Signee ,W:,,, •w.,,,• �:11 MASON COUNTY PUBLIC HEALTH 0. ' {' , ' -k The undersigned approves this Installation Report and .c.- 1 U 112 : �/+ Record Drawingon behalf of Mason CountyPublic Q� ADAM J.HUNTER 11 1•ic`t_ 81,_:11512n,,RJFA— t Health: • 1.101.1100".%106 �16‘. 1101.111" // I r,I.,riES u1,12! // . L Yin "� 1 Zit Signature of Environ rental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8,21 2�t8 1 Ask TZ cai W µ C X o m N O D = O ..� m 0 \ o ,0 , • 1'''� \01 \ y \ / o \\ o x CO m n z �. al � � �rn CO T S �= ) O in IN) in n 2 C.ri z a a0 nrn N RI 0 z m m D Z c H N �r, iyy, l od xti.>'N CO N X u 0* n u c... 73 o = -a4 0 z . x z 03° > o O m c C 0p v x mz _( t_,No rri _ O rn o m � nc m m ° O O 7J * 7 u) D * �° M Z w 0 --I C 0 op V) p K z -I o O N Z CA -I (-) 2 O K CD z o m q z = cn --I m D j > 2 ��j C3 Z r m D fl CO0 co(' m m o 0 N 0, Z W a w D N r m X