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HomeMy WebLinkAboutSWG2025-00200 - SWG As-Built - 10/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG o�Cs' 0 09-co Parcel# 22212-54-00906 Applicant Name Megan &James Kelly Subdivision (Name/Div/Block/Lot) Applicant Address 10 ki0111.6i m itj City, State, Zip PeA.-1--a "VA- 'B� Installer Name Jon O'Connell Site Address 70 E Graham Rd Designer Name Rod Left INSTALLATION CHECKLIST III Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Pressure treatment Type Nuwater >5 ft. from foundation? - - - ❑ N/A ❑■ YES El NO 401 >50 ft. from wells? - t � j ❑ ❑I ❑ • >50 ft. from surface water? - ') ' - - `- -- - - - ❑ ❑■ ❑ Z ; HCleanout between building and tank? - 1 - -r.GQ - - - ❑■ ❑ O " Tank baffles present? - 4- '��``'' — — - ❑ ❑■ ❑ F- 24" access risers over each compartment? `'" - ❑ ■❑ ❑ WEffluent filter installed?- 0 - - ❑ El Septic tank size 1250 gal Manufacturer Roth 0 D-box water level and speed levelers used? - - ® N/A LI YES ❑ NO DO``; Manifold/D-box accessible from surface?- - II El 032 Check valves installed? - - ❑� ❑ ❑ CQ E Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ■❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A El YES ❑ NO 0 >100 ft. from wells?- - ❑ ❑■ ❑ --i >100 ft. from surface water? - - ❑ 0 ❑ W ti '' >10 ft. from potable water lines?- - ❑ ❑� ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ re ' > 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?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank?- - ❑ N/A 0 YES ❑ NO • Pump tank size 1380 gal Manufacturer Roth < 24" access riser(s) and accessible from surface?- - ❑ I ❑ F- a Alarm or Control Panel Installed? - - ❑ II El m • Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ d Pump installed in E. Bucket or ❑ On Block or ❑ Other n'• Pump Make/Model Liberty 280 ❑■ Floats or ❑ Transducer a Tank draw down 1.25 in/min Pump capacity 27.5 gpm Squirt Height 5 ft Pump on time 2:10 Pump off time 4 hours Daily flow set at 359.9 gpd Updated 8/21/2018 9/10/25,8:50 AM `' Baker septic pumping, inc Mail-70 graham asbuilt form .- Mason County OSS Installation Report pg. 2 Parcel# 22212-54-00906 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? • - ® YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ® YES 0 NO RECORD DRAWING TAM is a permanent record and must be accurst*and descriptive enough to re-locate In the need of maintenance actvttles and tutors development Typcal Record Drawings contain: Cramfield&mamfcld orientation&layout.Sepacroump tank location.North arrow.reserve drainttid.existing and proposed buildings.location of wells,watiAnes, wets,observation ports.deancuts,and other maintenance access pants Incomplete Record Drawings may create adortIonel delays in final u,stallatlon approval and related permlts / Q Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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 ounty Codes. State and Mason County Codes I further e fy that all informati•n contained •. this I further certify that all information contained on this fo :nd ' ache- •-cord D . ing is accurate. form and attached Record Drawing is accurate. ilk Sig •= of Installer Date w Wilk 3or tit CO ' 1 I Printed Name of Signee ` MASON COUNTY PUBLIC HEALTH e��, ' •r The undersigned approves this Installation Report and ~`�4 J Record Drawing on behalf of Mason County Public J LICENs••a SIGNER iii/Angaiiiiii iiri ISak Health: EXPIRES 12115W 01\010\4(011 o(7(z J- G6/ 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 assi sots https://mail.google.com/ma iliu/0l?ik=c13302c85c&view=pt&search=all&permthid=thread-a:r-2920058543437967800&simpl=msg-a:r255814918980371... 2/3 0 C O > > a �c h. 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