HomeMy WebLinkAboutSWG2024-00385 - SWG As-Built - 10/1/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG ZOZI(- O ) Parcel# .?Iqug- 3 Z- 0 00-10
Applicant Name A C,isY1 Horv\tr Subdivision (Name:Div'Block/Lot)
Applicant Address 21,0] QJ q) r-yf 6() ' I
City. State. Zip 61.lf . to j,& 9 . Installer Name t-tp'k.. r
Site Address 1 I S Neat,' /Zo Designer Name n66 tyl Hlt
INSTALLATION CHECKLIST
06Fuit System Instaiia_- 0 Tank(s)Only 0 Dra:nf.e,a Only 0 Repai- ❑Ober
System Type OWOft Pretreatment Type
>5 ft.from foundation? - - 0 NVA Its YES 0 NO
>50 ft.from wells? - - 0 N ❑
z >50 ft. from surface water? jj Et-f flEJ1 Ei ❑ P, ❑
Cieanout between building and tank? - - - - � ❑ ❑
V Tank baffles present? SE �C 2025 - ❑ ( ❑
d24"access risers over each compartmen.. -� _ ❑ LrX�vn 0
4 w Effluent filter installed?- By ❑ eV 0
Septic tank capacity(working) 12 0 0 ga, • l--\(?. Preeleli-
S D-box water level and speed levelers used - - ❑ N'A ❑ YES *y Na
�O Menifold D-box accessible from surface% 0 ❑
mZ Check valves installed? -
2 Transport Line Size 2 Schedu.e°Class LS,Lhea 110 Qil=brc �;
Bedrooms installed(check one) 0 2 IP3 0 a El ❑o ❑CommercialiOther '"'']]
>10 ft.from foundation?- - ❑ NIA )YES jJ NO
>100 ft. from wells?- - 0 0
CI
-1 >100 ft.from surface:��ater? - - 0 0
w E.C. >10 ft.from potable water lines'? 0 0
- -
Z > 5 ft.from property lines and easements?- - 0 0
Q El ❑
OC > 30 ft.from downgradient curtain/foundation drains?
Drainfield level and observation ports present - - 0 le ❑
0 Graveless chambers or Clean gravel used? (check one;
Proper cover installed over drainf,eld?- - 0 tSP ❑
Pump tank setbacks consistent with septic tank? - - ❑n NIA DYES ElNO
Pump tanK capacity(flood) 1130 oat Manufacturer IAL` 0fP_Cal\4-
Z 24"access riser(s)and accessible from surface?- - ❑ Kk ❑
ta-- ❑
a. Alarm or Control Panel Installed? - 0
2 Control Panel equipped with Timer! ETM!Counter ❑ ❑
O. Pump installed in Bucket� or 1��On Block or 0 Other �7(1
a- Pump Make/Model�kW\ 1 . '2 L��)Floats or ❑ Transducer
dTank draw down _ '1....- in/min Pump capacity ''1 11, _crrn Scu'st He!aht S
Pump on time 2,S r- .r Pump off time -1 `\( . Daily flow set at 3(,a C) gpa
Mason County OSS Installation Report pa. 2 Parcel#
ABANDONMENT RECORD
Were existing septc components abandoned as alai c of t^s - - ❑ YES 0 NO
If yes. please describe: _ _ _ __ _____
Were all components pumped out and property abandoned per WAC246-272A-0300? - - ❑ YES 0 NO
RECORD DRAWING
T Ris IS a permanent reccrd and must be accurate and descr:pt:ve enough to re-Locate in t`e nced ci:ra:rteran;e acts t.es and future development. -j-:a R:::':
7)-avnros c ratan. ora•n`..et&-rar.toed oven Cn&layout.Sectopump UM baCettio.Norte mare reseree d a'`eie ex*s:^q arse r.Aosec Outings_locatiote dotes.eretera.-e
.+yeas.aoeerva:nr.zees c.eanc s,a^d eaeer era :arse access ports. rcomplete Record D-aw-^ss rray cease ass nor oezys ai_-xa7a:nn approves and reiaated peer
1Record Drawing Attache
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 deared/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 1 further certify that all information contained on this
fo and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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CikAALI
r7ature of Installer
�, e s. elf Gil,•01-
ff
\ Pa.. :'.
1 ,2 y�` / �5 v�eyq' i',1
=rntedNa^le;, Signee /IP �4'^ r '`tff
MASON COUNTY PUBLIC HEALTH �,:1 'Is,'* ,»uat2 ' t
The undersigned approves this Installation Report and ' 0 ADAM J.HUNTER f
Record Dra g on behalf of Mason aunty PubeCi ��CI VIVI) VIVIM1110101016
Health tO �CpUNry��Yi 7�?5
/ l �p//
S gna t.re Environmen;at Heats Specialist Date 0j4 Bf'Nl� _(stamp, signature and date/
� t
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC /1 ON +He MASON COUNTY WEB SITE Jpdeyd y3L1ct8
RECORD DRAWING (continued)
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