HomeMy WebLinkAboutSWG2024-00068 ADDING SOLIDS BASON TO EXISTING SYSTEM - SWG As-Built - 9/16/2025 1EC .E1WE
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Mason County OSS installation Report pg. 1 MASON COUNTY -1-1EALT_ _
APPLICANT/PERMIT INFORMATION
Permit Number SWG 202.9 — COO bog Parcel# �Z 33,25'1 boon Z.
Applicant Name ((G-.)-i- -Rocr Subdivision (Name/Div/Block/Lot)
Applicant Address @3 $oA%I►V .% Ct NO _
City, State, Zip O µie jS IAA /5 5Z. Installer NameE Q 'er -`. s.T}s<, A A
Site Address 574 r N L 65i1 4 RI Designer Nam5 - F}wr}'t r-
INSTALLATION CHECKLIST
❑ Full System Installation 115-Tank(s)Only 0 Drainfield Only ❑Repair 0 Other
System Typ l0s aestS i''t lz> -id; Pretreatment Type
• >5 ft.from foundation? - - NIA ❑YES ❑ NO
>50 ft.from wells? - ❑ ❑
Z >50 ft.from surface water? - - 0 ❑ CI
o < Cleanout between building and tank? - - 0 ❑ 0
o Tank baffles present? - - 0 ❑ ❑
P24"access risers over each compartment?- - El El
111J Effluent filter installed?- •- El Di ❑ •
Septic tank size gal Manufacturer
•
0O D-box water level and speed li velers used? - - 6WA El YES El NO
O Manifold/D-box accessible from surface?- 0 0
OZ Check valves installed? - - ❑ El ❑
Transport Line Size Schedule/Class _
Bedrooms installed(check one) ❑ 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ri NiA ❑ YES ❑ NO
0 >100 ft.from wells?- - ❑ ❑ 0
W >100 ft.from surface water? - - ❑ ❑ ❑
u. >10 ft.from potable water lines?- , - ❑ ❑ 0
▪ >5 ft.from property lines and easements?- - 0 0 ❑
02 >30 ft.from downgradient curtain/foundation drains?- - 0 0 ❑
O Dralnfleld level and observation ports present - - 0 0 ❑
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover Installed over drainfleld?- - ❑ 0 0
Pump tank setbacks consistent with septic tank? - - ❑ N/A YES ❑ NO
• Pump tank sizea.0 gal Manufacturer°Ake
Q "'access riser(s)and accessible from surface? s, - ❑ tigf _ ❑
~ Alarm or Control Panel Installed? - - ❑ 0
n. ,�.�
• Control Panel equipped with Timer i M/Counter- F} No , -- 0
n- Pump installed in ❑ Bucket or ❑ On Block or pcOther Op 'fww,,,4 -b 20 66 ook.
CL Pump Make/Model (2)q(ne) �5'E-c Floats or ❑ Transducer
0 Tank draw down t0 in/min Pump capacity gpm Squirt Height 'Nt' ft
R.,
Pump on time N'0 Pump off time Daily flow set at tit, (Pi- gpd
updated 8f21f2018
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 `Es r,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: Drainileld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drain field,existing and proposed bulldkrgs,location of wells,waterlines,
wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays In final Installation approval end related permits.
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t. 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 ttached Record Drawing is accurate. form and attached Record Drawing is accurate.
•
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Sig ture of Installer /- Date
' ,NActi, 1/,
Printed Name of Signee i,� .4° ti� 1�F.
MASON COUNTY PUBLIC HEALTH /``' �'` w<
•
The undersigned approves this Installation Report and stovz�3 J• �F
•
O !AMES R.HUNTER �'
Record Drawing on behalf of Mason County Public 1C tie R -
Health: EAPPR«: 03/22/
cri\sil/VV(041 6t((-(7(7c-
Signature of Environmental Health Specialist Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2112 0 1 8
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