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Home My WebLink AboutSWG2025-00296 - SWG As-Built - 9/19/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 202. -W2q u Parcel # 72330 -16-000 u 0 Applicant Name Tat a RA 1 riot KS Subdivision (Name/Div/Block/Lot) Applicant Address pp R)M>(°l°I�Z TK Wpf-Survki 40-15$ I/i5 iOr in s`108 C;i.Si OFizpv City, State, Zip •,Seattle.4.1A 6101 l Installer Name Map" EXW U1984PpinL Site Address 4g7 N Ifill1 1N0q Designer Name INSTALLATION CHECKLIST ❑ Full System Installation EliTank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type GTO 1/111 - reatment Type i >5 ft. from foundation? - \T - ❑ N/A ErYES ❑ NO >50 ft. from wells? - -��- ❑ ❑ • >50 ft.from surface water? - % - - �� - - - ❑ S ❑ z - off 4� ❑ Cleanout between building and tank? - � � � - ❑ U Tank baffles present? - - - - ■ [ ' ❑ a24" access risers over each compartment? - - - - - - ❑ L" ❑ W Effluent filter installed?- g- - •- ❑ d ❑ co 1Z InfiltraTO( Septic tank capacity (working) rJ� gal Manufacturer 0 D-box water level and speed levelers used? - - ElN/A ElYES El NO oO Manifold/D-box accessible from surface?- - El ❑ m2 Check valves installed? - - ❑ ❑ ❑ OQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 2{3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation? - - ❑ N/A ❑ YES ❑ NO >100 ft. from wells?- - ❑ ❑ ❑ o W >100 ft.from surface water? - - El ❑ Er_ >10 ft. from potable water lines?- - ❑ ❑ ❑ Z > 5 ft. from property lines and easements?- - El ❑ a El El ❑ � > 30 ft.from downgradient curtain/foundation drains? - - 0 Drainfield level and observation ports present ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with se•tic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tank capacity (flood) •:l Manufacturer Z - ❑ ❑ ❑ < 24"access riser(s) and accessible from su .ce?- F- Alarm or Control Panel Installed? - ❑ ❑ ❑ O. 2 Control Panel equipped with Timer/ ETM /Co er- - ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ 0 :lock or ❑ Other d Pump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/m' Pump capaci gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8'21/2018 Mason County OSS Installation Report pg. 2 Parcel# 3_2 -fi5-OO(Pa ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - d YES El NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - QIYES 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: Drainfield&manifold orientation&layout,Septic/pump 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 additional delays in final installation approval and related permits. 11/4/vv\hl w6-5 c 4 yr howv.. (7el"), CO'fait ikciA) h 6r2 6'444-1- 3c4 +ant-- 42"-‘ 7"f-c-7 (Lq 11-.7" [Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER 1 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 1 further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 811Li 12Cj Signature of Installer Date \S YJ4n?i MGlpt�� Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: jclvd(Nrinfq °LliCt 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;2112018 RECORD DRAWING (continued) .41=1' APpR S O VED MASON CGUN EP 1 2025 rvEN0,0,,nivisimENrA REr "HEALTH 1 t��ISe •0 Snop New 1250 qqaU i\ inidtroAtt' same t,ocaMA a( f�cltled Titrk pirCel �2 l3J �-000 LPO