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HomeMy WebLinkAboutSWG2025-00345 - SWG As-Built - 10/10/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00345 Parcel# 319045300023 Applicant Name Martha&Bruce Karr Subdivision (Name/Div/Block/Lot) Applicant Address 1770 SE Crescent DR Fawn Lake City, State, Zip Shelton Wa 98584 Installer Name Wes Graves Site Address 1770 SE Crescent DR Designer Name N/A INSTALLATION CHECKLIST El Full System Installation ®Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type r tment Type >5 ft. from foundation? - P_S�� El N/A ©YES ❑ NO >50 ft. from wells. - ..i.\\;.2k., II 0 >50 ft. from surface water? - k!-t -.st? l.�a�5-- - ❑ 0 ❑ FQ- Cleanout between building and tank? . El CI t��; - - ❑ U Tank baffles present? 0 0 1�- - - - d 24" access risers over each compartment?'-'By-- - El Cl W Effluent filter installed?- ❑ 0 ❑ u) Infiltrator Septic tank capacity (working) 1530 qal Manufacturer 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO oO : ifold/D-box accessible from surface?- - ❑ ❑ 0 mZ Chec' -Ives installed? 0 u. ❑ ❑ oa Schedule/Class • Transport Lin- ize Bedrooms installed (c' = k one) ❑ 2 0 3 ❑4 El 5 ❑6 ❑Commercipl%Other >10 ft. from foundation?-- - 0 N/A ❑ YES ❑ NO CI >100 ft. from wells? ❑ ❑ ❑ W >100 ft. from surface water? - - ❑ 0 LT >10 ft. from potable water lines?- 0 ❑ ❑ Z > 5 ft. from property lines and easements?- - 0 ❑ ❑ x > 30 ft. from downgradient curtain/foundation drains?- - -- - - - - 0 ❑ 0 o Drainfield level and observation ports present - - 0 ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (c.-ck one CI cover installed over drainfield?- - ❑.. 0 Pump tank setbacks consistent with septic t. ?- - El N/A ❑ YES ❑ NO • Pump tank capacity(flood) gal Manufacturer Z Q 24" access riser(s) and accessi from su• .ce?- - ❑I ❑ ❑ ~ Alarm or Control Panel I Iled? - - - ' - - - - - - - - - - -- a , ❑ • Control Panel equi d with Timer/E oun - 0- Pump install in ❑ Bucket or !! a ¢I k r ❑ er O. Pump a/Model 0 Floats or El Tr nsducer � ft EL Ta draw down in/min Pump capacity gpm Squirt Hei EL ump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 319045300023 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - YES ❑ NO If yes, please describe: Removed Old Septic Tank Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Q 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: Drainfield&manifold orientation&layout,Septic/pump tank location.North arrow,reserve drainfield,existing and proposed buildings,location of and wells, wate elated erlinemi , wells,observation ports,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval ii Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI 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 deviationsboth here have been cleared/approved by both the designer shown andre Maveebeen cleared/approvedn e Public Health and meet all by and Mason County Public Health and meet all State myselState and Mason County Codes and Mason County Codes. I 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. 6( ¢4- 09-17-202f Signature Installer Date Wes Graves Printed Name of Signee MASON COUNTY PUBLIC HEALTH ,_, ;- The undersigned approves this Installation Report and Record Drawing on behalf of Mason Coury#y Public s '+,:_, Healt . 716-43,04,COU OC r J 1 0 (/ 15 ,n, Signature of nvironmental Health Specialist Date 0J4 /✓4ff4/ (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC` CIN THE MASON COUNTY WEB SITE Undated 8/2112ot8 RECORD DRAWING (continued) 9 \l , t` A s o ..- 11 (5' --5.-- v-- �yG Iv I- 0 d ,,i) ,,, , tri - Fs- is c_P• ,s,,Y 1 2 -p, '3 ma`s `('..^, ° '� T 5 % (- q��q 3 lJ ti