HomeMy WebLinkAboutSWG2025-00111 - SWG As-Built - 10/13/2025 •
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Mason County OSS Installation Report pg. 1 MASdN COUNTY PUBLIC HEALTH
APPLICANT!PERMIT INFORMATION I
Permit Number SWG 2 a 2 S'-- oo /// Parcel# SZO 2—Y j// - gal`7/47
Applicant Name t3cady sA,voo r.47 1-- Subdivision (Name/Div/Block/Lot) ,
ariApplicant Address /4/3 id. .Z',vs�Ll /W. SP, -,�/ 73` Lcir /9-F '�y�e.-Pr, 4-IL
City, State, Zip ..ch4.447d41, iv/1 f8c1 f Installer Name 14/4e/c fl Wv c-c;t/s'rnvc/W
Site Address 7/66) w Lily,/L,raveo ,,e). Designer Name 1 441.Pis T'-,e-c>/r-
INSTALLATION CHECKLIST
la Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type fAv.0 / h O ,5 - Pretreatment Typo 4/4 {
>5 ft.from foundation? - - ❑t�IA �.YES 0 NO
>50 ft.from wells? !tri%
� ❑ . 0
ester? - ❑ ' ❑
Z• >50 ft.from surface a Q�T� 1 ; ;HCleanout between building and tank? - NI- .-1- ❑ I 121 „°
U Tank baffles present? El ; `
d 24 access risers over each compartment --- - - - .--1---- ❑
111 Effluent filter installed?- - -- -- - ❑ ! ET:.
co
Septic tank capacity(working) `�v gal Manufacturer S W+ j COM-1
0 D-box water level and speed levelers used? - - 0 tl/A ❑YES •"4 NO
DO Manifo{d/D-box accessible from surface?- - 0
u.
mz Check valves installed? - -- ❑ 1 0
CIQ I
2 Transport Line Size p Schedule/Class 7t
Bedrooms installed (check one) 0 2 Dia 3 ❑4 ❑ 5 ❑6 ❑'Commercial/Other
>10 ft.from foundation?- -- ❑ Iva 53 YES ❑ NO
>100 ft.from wells?- - El ® 0
CI
-1 >100 ft.from surface water? - - ❑ VI ❑
ill
r >10 ft.from potable water lines?- - 0 0
I >5 ft.from property lines and easements?- .. ❑ ® ❑
ilt > 30 ft.from downgradient curtain/foundation drains?- - ❑ EU ❑
Drainfield level and observation ports present - ❑ 0 0
❑ Graveless chambers or (,a Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ R 0
—Pump tank setbacks consistent with septic tank? - - ❑ N/A Ca yes 0 NO
Pump tank capacity(flood) 12L dal Manufacturer 15.c.)Q,n,A F 1-4-
R 24"access riser(s)and accessible from surface? 0 53 ❑
} 0. Alarm or Control Panel Installed? - - Cl El ❑
a g Control Panel equipped with Timer/ETM /Counter- ❑ 0 ❑
-
D
a- Pump installed in [XI Bucketor 0 On Block or 0 Other
d Pump Make/Model -2
odel ,lI Q>! — \�/ Floats or ❑ Transducer
a
Tank draw down `Z.. if in/min Pump capacity IjJ/1/A' gpm Squirt Height .2_I Pump on time 1 I ft
0,Jv�, Pump off time (Q AO ('s Daily flow set at 1). gpd
Updated 8/21/2018
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WI ♦M I a A Y f y ti • Y R [ .1.* y
RECORD DRAWING offelfho and how*or.f000fffoot. r
T>M it i• 4 rUele4 W ff losov w.fer R•�s r wboi�.....1.00r*to w'aJo`M drieleid M Mod peo'puMMf re Qr.*wow de mete.
orriledreet
£<Y a ;i �Me soft+roo ro ae♦moc•wicia wadot *9W bcehm. aeele edd'elonaldetny!M drat Fist+ 'to`Wfi `
�a�pai*�Aw`tw"k �et°`r�R '�r�C� ex'a*�a Record[kewt+ps^'w
Record Drawing Attached
CERTIFICATION OF INSTALLATION( I
'0
INSTALLER DESIGNER' ENGINEER
• I certify that I installed the system in accordance with I certify th the system has aeen t
,APPROVED"by
led in accor-
the septic design stamped"APPROVED"by Mason dance with
the septic design stamped
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 and Masonere have been County Publrcpproved by Heafth and all oth ,
and Mason County Public Health and meet all State Sate and Mason County Codes
and Mason County Codes.
1 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.
N.'s-jtv11-‘1 �1 icy- ) -I-5 "
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Signature of Installer Date - 'a,04''''-i Vr f iJ I[1IC in i \ ems' + ..
nee
Printed Name of Sig ,.••
�� A. eaoe� •
MASON COUNTY PUBLIC HEALTH ;� =�� G
ned approves this Installation Report and i
The und�rsig ��aZ .
;•• on behalf of Mason County Public
,„„
4,r piisi Dare (stamp, signature and date)
;w •ND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updatea812'12°18
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