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HomeMy WebLinkAboutSWG2024-00114 - SWG As-Built - 10/13/2025 , Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2ct'. (. j`\U( Parcel # Nq )L1 1u`GOOSO Applicant Name 06-\6 . .e.,U0A Subdivision (Name/Div/Block/Lot) Applicant Address po h1ic 12;00\&,City, State, Zip 9\IQ , 0R. 972 }9 Installer Name 1,-\c 1in . Site Address \ V. J\' Designer Name R? Lr \ �Tv it INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Draintield Only El Repair ❑Other System Type 1, rQ&�VC tment Type >5 ft.from foundation? k i- ❑ N/A ES ❑ NO >50 ft. from wells? g ❑ ❑ • >50 ft. from surface water? ;ias_ -'• ❑ El Z HCleanout between building and tank? - DC ❑U Tank baffles present? - ' - - -- ) ❑ E. 24"access risers over each compartment. -B�- - - - . - -- - ❑ ❑ W Effluent filter installed?- - El El Septic tank capacity(working) W1 gal Manufacturer sD-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO �O Manifold/D-box accessible from surface?- - El ❑ C1 Check valves installed? - - ❑ ❑ ❑ Q 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 1'1 4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A YES ❑ NO O >100 ft. from wells?- - ❑ ❑ W >100 ft. from surface water? - - ❑ ❑ ti >10 ft.from potable water lines?- - ❑ 0 z > 5 ft.from property lines and easements?- - ❑ ❑ Q cK > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ fzi Drainfield level and observation ports present - - ❑ ❑ ❑ Graveless chambers or tciClean gravel used? (check one) Proper cover installed over drainfield?- - El ' ❑ Pump tank setbacks consistent with septic tank? - - El N/A IYEs ❑ NO • Pump tank capacity(flood) \ M gal Manufacturer \* (Cep Z H24"access riser(s)and accessible from surface?- - ❑ N 0 Cl. Alarm or Control Panel Installed? - - El 179 El 2 Control Panel equipped with Timer/ETM/Counter- - ❑ ' ❑ n- Pump installed in ❑ Bucket or `-P On Block or ❑ Other Pump Make/Model �,��Q(�� L((_L V [)Floats or 0 Transducer 4 a Tank draw down 2 in/min Pump capacity cle0 gpm Squirt Height ft Pump on time 1, 6 7 '— �— Pump off time 11 4zi Daily flow set at 1-f$O gpd Up,aeJ e'21 2 e Mason County OSS Installation Report pg. 2 Parcel tt ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES NO If yes. please describe. Were all components pumped out and properly abandoned per bAAC246-272A-0300? - - YES 0 NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development. T,,.ca:Recc•a Drawings contain Dra'tf elc 3'narrfoid o.•:entaticn 3 iayo..:.Sec:--c'pump:ank coca:an,No-:n arrovi reser.e dran'.era exist rg and pror,osec toad-gs scat on o'wells wa:er.fines Observa:on rcrts cleanouts a-c croer rra i:enance access porr:s. Incomple:e Re:oro D-atnngs may create add:ona Delays in final instai:a:4n apo-cral and rela:ed perrr:5 Record Drawing Attachec 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 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 I further certify that all information contained on this for 7 and attached Record Drawing is accurate. form and attached Record Drawing is accurate. S gnature of Installer1Date >(-) 10/10/25 Printed Name of Signet r II•r MASON COUNTY PUBLIC HEALTH ?,_• The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public ' } :, Health• � *DAt.1 trrnt1ER •. \Q )1(ile(Ofik (6( 13rac— -SISINZSSINVZI. • Signature of Enviromnenkal Health Specialist Date (stamp. signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY SITE • • ;,68L •• P m \ II •• , Q < Cl) * v 03 • Ao c (I) Fmx V o mm o /4�/5O 0 ' 1Cr,z 0 m 0SSFS 73 M r Om �� • m • o �/ II 11111 `. I WI w '`..... i © O6 IIIII in µ I11I II \ A • • `• • • • • • • m ` m D P 0 ` 4 • jT � o • r `` I11111IIIil � � O \ 1111111111I m N C \\ tTl rn r � lli1111I1y \ 1111111111II ! = m •i 1 11 \ IIIIIII w 0 o c No m I O z O x 1 rn a O.. N n ID c r I -J It * n 1�-1 Z ' 0 = O x p z •W v cn -0 Z o � � � `%�� 4111% ,,, Tc1 lm^ m CD 1�l N 'L "•$`y.\L� .. Z Jm! _ .'il O RIO S L i �- Z co K p Ci)O I' ••_� .' 0 Z r' OD 13 W l o -1 N a v, T, v Z n 01 COO m D m m .-1 m Z # rD DO AVi pr C Z p m r D p o m m p DACo Nm =Gi o ' m N q rzi m m :U rsa 4 j3 D cn .....I (A 8 cn. r al A a 1