HomeMy WebLinkAboutSWG2024-00151 - SWG As-Built - 10/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY F'Uf3LIC HEALTH
• APPLICANT/ PERMIT INFORMATION •'••
•. 'Permit Number SWG 1 o Q I 5 _ Parcel II 3 7 12"15 2 v go l a_ ...__
•
Applicant Name sya„ iorK Subdivision (Namo/DiV/f.3iock/I_ot)
Applicant Address 1,1 t0 LS►,o)( C..d- ANa --- -�---- -
City, State, ZipU1yntPIA WA. ��SO Installer Name . - . urN,y.,adiS I- --
Site Address d S��aMro�Et fir Designer Name µ+�l�r -- —,
.
• INSTALLATION CHECKLIST •. . .•..
f Full System Installation 0 Tank(s)Only 0 Dralnflold Only 0 Repair ❑Other -
System Type Nv wtatr ko 5ub slaw otip treatment Typo Wv. ytdkr- .. ---
>5 ft. from foundation?T /� __- - ❑ N/A U YES ❑❑ NO
• >50 ft.from wells? - ,/ 0 PAY • >50 ft. from surface water? - ( -- - 0
\V _ 0 0
.
? Cleanout between building and tank? --�Q� -
U Tank baffles present? - .\ --43--- - - ® ❑
►=:. 24" access risers over each compartment 0 [21 0
W Effluent filter installed?- - -- --"- 0 ® 0
Septic tank capacity (working) IO4/ \ i-f/Manufacturer Sov ertutb� ��ft ti00
Q D-box water level and speed levelers used? - J - PSI NIA ❑YES ❑ NO i
o0 Manifold/D-box accessible from surface?- - 0 n 0
m Z Check valves Installed? • . - 0 ® 0
`t .:1' Schedule/Class 40
• Transport Line Size
Bedrooms installed(check one) 2 2 ❑3 0 4 0 5 ❑6 0 Commercial/Other
>10 ft. from foundation? •
❑ N/A ®YEs ID NO
O >100 ft. from wells?- ,, . 0 ® 0
•
w >100 ft.from surface water? • • - 0 ® 0
>10 ft.from potable water lines?- ' \ - 0 ® 0
> 5 ft.from property lines and easements?- - 0 R ❑
e >30 ft. from downgradient curtain/foundation drains?- . - ❑ ® 0
• Drainfield level and observation ports present - - 0 ® 0
0 Graveless chambers or 0 Clean gravel used? (check one) 54Sw4Acti rkri P
Proper cover installed over drainfield? - 0 NI 0
Pump tank setbacks consistent with septic tank?- - 0 N/A tSt YEs ❑ NO
�L Pump tank capacity (flood) ILA/S gal Manufacturer SckA4, pr t •-
Q,. 24"access riser(s)and accessible from surface? ❑ ❑
Alarm or Control Panel Installed? - . 0 Ea ❑
2 Control Panel equipped with Timer/ ETM/Counter-• 0 ® 0
Q- Pump installed in 0 Bucket or 2 On Block or 0 Other
a- Pump Make/Model orfAct yl.t\P 10 GP" PP StrieS El Floats or 0 Transducer
Al"xe
a.• Tank draw down ^in/min Pump capacity.Lgprn Squirt Height A- ft
Pump on time "3.5 wv n Pump off time„JoeLrS Daily flow set at 9-.Lk4 gpd
Z upd,uud as 1-2o i$
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. Mason County OSS Installation Report pg. 2 I';Irr`'I if __._...._._ —• -- .
ABANDONMENT RECORD
Were etrst'np septic components abandoned as {tart of Ihrs prolt+ct% . . r-i
t yes please descnbe
_.__ .. 0 YES I Prri
\Vcr'e an tVmponents pumped nut and property abandoned per WAC24G-272A-03007 - _ .- -
RECORD DRAWING
rho,It a permanent re not and niu I be accurate and dectlpllve enough to ne locate In the need of maintenance artdvltlet and ddure de'retnpment 7II,t'
�errr,d
n'aavrgt(' a'' Ik004rd S mat'otd onentat cn.A.Isyaa,a.p rcpr'r p lank local en.North arrow haters dramde'd errod,rg and rrnrn"e't IN"H'gt ,r.rr+f nr nw H rr e,..,ret
„rDt cb 'n,l.,,1';'ac ctearootc and other rxtmtennre ancele pone Incomplete Record Drawings may create addeemat dela?,m deal r.ctallrl»n ar41v at an't retired✓e'^'at
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❑ Record Drawing Attached
• CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
/certify that I installed the system in accordance with 1 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 I fu certi )at all information contained on this I further certify that all information contained on this
f tta Record Drawing is accurate. / form and attached Record Drawing is accurate.
Signature of Installer Date
''V;/—'
Printed Name of Signee 4F.:- \`'
MASON COUNTY PUBLIC HEALTH F t .'11,
The undersigned approves this Installation Report and f _= '' ,- s, •
Record Drawing on behalf of Mason County Public -,_`. r ,, t,_Ir:TER
Health: � :..l...crt,t.. ..... ..,...iI,kif'p;. .
�/I 7 c1S —r
Signature of Environmental r1$ealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE LWet''.n 62'. 1'
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