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HomeMy WebLinkAboutSWG2025-00039 - SWG As-Built - 10/13/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2LZS.- Oo ,:(1 Parcel # Z2'ZvZ-"lU - CUtCC: Applicant NameQ -4-Ltn(i(,L CL1Nk Subdivision (Name/Div/Block/Lot) Applicant Address I MI f .- 132.1 ,S4 . City. State, Zip k€111piv •LAA 990S% Installer Name ikt 811...) ?(;i1:1i`. Site Address 3C/0 A)f; Mui4h,\Jti'e 11d. Designer Name Ai X pc i{ - INSTALLATION CHECKLIST 0 Full System Installation 1=1 Tank(s)Only ❑ Drainfield Only ❑ Repair [,Other U r(%[k' System Type aL .1-\ ry1 Pretreatment Type 1 >5 ft. from foundation? - -- ' }•. - ❑ N/A NI YES ❑ NO >50 ft. from wells? �_.._ti'{z - ❑ El ❑ Z >50 ft.from surface water? - �6 - - - - < Cleanout between building and tank? :=' - 4 C -a� '� - ❑ IN ❑ C.) Tank baffles present? - - - - - El © El F- 24- access risers over each compartme t2- - - • - - - - - ❑ ® Elc. roy El Effluent filter installed?- - El la cn Septic tank capacity (working) ( 1 W gal Manufacturer L ) U \ 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - El El co, Z Check valves installed? - - ❑ ❑ ❑ CiQ �\ Schedule/Class Q_�\�hr � Transport Line Size � 1\� Bedrooms installed (check one) 0 2 ❑ 3 -43t4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A (N YES ❑ NO O >100 ft. from wells?- - ❑ Ea ❑ W [1 fa El ft. from surface water? - - 1 >10 ft. from potable water lines?- - ❑ ©- 0 Z > 5 ft. from property lines and easements?- - ❑ g- 0 Q - ❑ Q ❑ CL > 30 ft.from downgradient curtain/foundation drains? ci Drainfield level and observation ports present - ❑ &I 0 ❑ Graveless chambers or ist Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0, ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A AYES El NO ZPump tank capacity (flood) NV., Manufacturer h.Xwa1 1 Q 24"access riser(s) and accessible from surface'? - ❑ J N ❑ ~ Alarm or Control Panel Installed? - - ❑ a 0 c. 2 Control Panel equipped with Timer/ ETM/Counter - ❑ - 0 " Pump installed in ❑ Bucket or EZI,On Block or ❑ Other Pump Make/Model ®'Floats or 0 Transducer Q. Tank draw down in/min Pump capacity gpm Squirt Height i ) ft Q. Pump on time Pump off time Daily flow set at 7 L( `, gpd .,;.03:_...2'2_ _• Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES U NO �. If yes. please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ID YES 0 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. Tyi.icat Record Drawings contain Drainfielo&manifold orientation&layout.Septiopump tani iocaucn.Norm arrow.reserve drainfielo.existirg and proposed build ngs location of wells.waterlines. :dells.observation ports.cleanouts,a"o clner maintenance access points. Incomplete Record D•awings may create additional delays in final installation approval and related perrr-ts Er Record Drawing Attached , CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER l 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 I further certify that all information contained on this 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. r ,,,� all 1 del 10/5/25 0 i nature of Installer Date 'i -,-I+, r_,6, OV.)\ -- 0 04, i Printed Name of Signee ` if MASON COUNTY PUBLIC HEALTH el 7 ' �- ` IPA. r'Lc• ---Ai.The undersigned approves this Installation Report and �� , clam Record Drawing on behalf of Mason County Public = -. ALf X La E DAVW i Health: ,-,t. - ,s, 6( rsrtC- Signature of Environmental alth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE i / ' / /i / � DECOMMISSIONED WELL / / 0��� :7--- 210 SF RESERVE % `-)N / I 14'x 15' �O� / / / 0 , � Q STORAGE/SHED •-- (OLD CABIN) , . 0 1 1 ABANDONED 055 4TH GLENDON MODjr6 0 INSTALLED PER DESIGN 2 I 1 OI' I EXISTING 3 BEDROOM I_ - _ EXISTING TANKS GLENDON SYSTEM --- I 1200 GAL. SEPTIC TANK �N PRIMARY & RESERVE N� 1200 GAL. PUMP TANK ` _1---- / — / gat�N\ / --- I- EXISTING GARAGE / I N N \(1 \ // I `� G // II 1 EXISTING 3 BEDROOM / i \\ / am 111111111- HOME TO BE REMODELED // EXISTING WELL I EXISTING \ / II -� \\ I7-- WELL `` R1 \` \\ i 1 Opp / 10 \\- \ ° I // R/ i 1 \ ,...4 ` EXISTING .\1 ‘�� OHWM // WELL 1 - `I- /I I\ I _\ / AP OVER \ - _ I HOOD CANAL - / ,� OCT1,Z 2025 I 1 - _, . .,' I 1 �.�.;� MAS0N COUNTY ENVIR0�I+14WAL HEALTH I ———— —�——' �' �;•'� �'�`�+, RET ---"--- ` , � / ___i MOMt / — — s ALEX LOue PAM( • T / It'll M N RECORD DRAWING // ..,,Is / CUSTOMER:PETER CLINE TEST HOLE 1 TEST HOLE 2 TEST HOLE 3 /N 4� 0-15"51 LOAM NA NA / i I ,..I PARCEL: 22202 - 14 - 00100 THli015" ALPINE SEPTIC SITE:3901 NORTH SHORE RD —DESIGN-- ALEX L PAYSSE,DESIGNER SHEET:ASBUILT SCALE: 1"=30' DISCLAIMER: THIS IS NOT A SURVEY. REFERENCES INCLUDE:APPUCANTICOUNTY PROVIDED PLATS OR 3089 E MASON BENSON RD SURVEYS.FIELD MEASUREMENTS AND COUNTY GIS. DESIGN INTENDED FOR SEPTIC PURPOSES ONLY. PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER DEPARTMENT/AGENCY REVIEW. DESIGNER NOT GRAPEVIEW WA 98546 I I _ RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS. 380.507-1648 Ic Ic_ I I