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HomeMy WebLinkAboutSWG2025-00305 - SWG As-Built - 10/13/2025 ° . Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG % .- 60 Vic' Parcel # jca , eso3 Applicant Name J iv/,io 7 Pile Subdivision (Name/Div/Block/Lot) /3 Applicant Address /` ` 1 l )9/", Pf City, State, Zip gi4-=1&N , ge,r� Installer Name /54 Rik - Viciisy, c Site Address /f?f P �/jIL- -i Designer Name V/4. 7^�¢7We / ` y INSTALLATION CHECKLIST In Full System Installation Tanks)Only 0 Drainfield Only 0 Repair ❑Other System Type Pretreatment Type >5 ft. from foundation? - --- El N/A J'YES ❑ No >50 ft. from wells? - ❑ El ft. from surface water? - - - - - -? '_-- -- ❑ El Q Cleanout between building and tank? • - - ` �1 -- LuL U Tank baffles present? Al- ;__Q�� __ _ _ _ ❑ El a24"access risers over each compartment?- -_ - _ 0 0 cW Effluent filter installed?- - - - .c_1 4)- OA. 0 El Septic tank size /,2-, + gal Manufacturer A41 IASI) 9 D-box water level and speed levelers used? - - AN/A ❑ YES ❑ No OLLO Manifold/D-box accessible from surface?- - IDJR 0 C C Check valves installed? - - El Tik ❑ er n Transport Line Size j Schedule/Class ,seji 4,0 Bedrooms installed (check one) 0 2 l"� El 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A AYES ❑ NO >100 ft. from wells?- VAtti ue. 4„, r;/C ❑ 0 W >100 ft. from surface water? - Elfg ❑ it >10 ft. from potable water lines?- ❑ RI 0 z > 5 ft. from property lines and easements?- - ❑ Ed El > 30 ft.from downgradient curtain/foundation drains? - - El a El © Drainfield level and observation ports present - - El IR 0 ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 El El Pump tank setbacks consistent with septic tank? - - 0 N/A ( YES El NO Pump tank size lI.� a gal Manufacturer /1/ /-31) /�' 24"access riser(s)and accessible from surface?- - El JO ❑ n. Alarm or Control Panel Installed? - - El RI 0 n Control Panel equipped with Timer/ ETM/Counter- - El54 0 a- Pump installed in ❑ Bucket or KOn Block or ❑ Other CLPump Make/Model L/& Pe 3/ ❑ Floats or (''Transducer Tank draw down i in/min Pumpcapacity '' \\ a., //� p y gpm Squirt Height e:3/4„,,,/„,, ft Pump on time Pump off time 7,3? M"v Daily flow set at_ 3kr, , gpd Updated 8121 12 0 1 8 r , . Meson County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ,YES ❑ NO If yes, please describe: e/(i t c` 1 c yC Pun-, Were all components pumped out and properly abandoned per WAC246-272A-0300? - KYEs ❑ 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: Drainfleld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfieid,existing and proposed buildings,location of wells.waterlines, wells,observation ports,cieanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final Installation approval and related permits. 4.,„..4,,LJ Fle,,,,, ,ce& , ,,q, ,415fic-Oid Drawing Attached 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 cleared/approved by both the designer shown here have been cleared/approved by both and Mason, ounty Public Health and meet all State myself and Mason County Public Health and meet all and Maso County Codes. State and Mason County Codes I further - :rtify that all inf.r ation contained on this I further certify that all information contained on this form a • -ttached R o •• awing is accurate, form and attached Record Drawing is accurate. .-- 4. Signe' of installer //�� Date llf P 4/1- tilit 14( Printed Name'of 5lgnee 4444"fl.,,,, r MASON COUNTY PUBLIC HEALTH ;e�- /An CI �" The undersigned approves this Installation Report and / 'VC L)V' I I Record Drawing on behalf of Mason County Public 7..;1 Health: aSignature of Fnvironm MI Health Specialist Date (stamp, signature a ) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8!21/2018 01111111111111.1. .............• c., • -k(-_-, . . ..1-.k , .... - , . , . ,.., :,,,, ,, • . . 7 3 ,. 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