HomeMy WebLinkAboutSWG2024-00228/ASBUILT - SWG As-Built - 10/21/2025 CLEAR FORM
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICAcT!!PERMIT INFORMATION .
Permit Number SWG 10 9-`1 — OQ7,Nt .Parcel # 3 19 C 7 0 O O 2`{O
Applicant Name r-fttkiveN rant, LL(, Subdivision (Name/Div/Block/Lot)
Applicant Address 2 i'2-4 ab1-104t 4vt. 5uik 3l0 ticare,a park
City. State, Zip Sc.t f-It, WA_ goto1 Installer Name mg, il sift,worits LLL
Site Address I'M/151 yr Fstcd.,n LA Designer Name �"otn h0 44,4 600y, soh(
INSTALLATION CHECKLIST
• 0 Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair taOther J Skrin n
System Type culrvA,Ilzky es '- J aleatment Type
>5 ft. from foundation? - < ., 1- �,, - ❑ NIA M YES ❑ NO
>50 ft. from wells - 1 �13}1.r ❑ ❑
Y >50 ft from surface water? - ` `� {� 0.'1_-�1-` ❑ ® ❑
Z �. -\
• Cleanout between building and tank? -- - ❑ ® 0
✓ Tank baffles present? - �� __z- ❑ ® ❑
1- 24"a. access risers over each compartment?-�,--- `- CI EZ CI
tW Effluent filter installed?- �� - - ❑ tM 0
Septic tank capacity(working) 1100 /1.1-to gal Manufacturer SOwn& prtc.abT
`CI ® ❑YES ❑0-box water level and speed levelers used? - - N/ANO
8O Manifold/D-box accessible from surface?-
co Check valves installed? - - ❑ ® ❑
E Transport Line Size 2.‘/2 t Schedule/Class 40
Bedrooms installed(check one) ❑2 ❑3 ❑4 ❑ 5 ❑6 ®Commercial/Other
>10 ft. from foundation?- G`6 "-it-J'}.- iA- - --- - ❑ N/A (N YES ❑ NO
>100 ft. from wells?- - 0 ❑ ❑
W >100 ft. from surface water? - - CI El ❑
u. >10 ft. from potable water lines?- - 0 2 0
Z
> 5 ft. from property lines and easements?- - El ® ❑
a
Q >30 ft. from downgradient curtain/foundation drains?- - 0 El CI
Drainfield level and observation ports present - - ❑ ® ❑
0 Graveless chambers or (3 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ra 0 •
Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES 0 NO
2 Pump tank capacity(flood) $9,5 gal Manufacturer Sow+3. Pr'rcaat`
Q 24"access riser(s)and accessible from surface?- 0 (l ❑
E-
a Alarm or Control Panel Installed? - - ElEl
2 Control Panel equipped with Timer/ETM/Counter- - 0 ® ❑
D
C- Pump installed in 0 Bucket or Cgr On Block or 0 Other
a. Pump Make/Model ZOc,lle, F t%S 23ovae 12 Floats or ❑ Transducer
a
Tank draw down 3' in/min Pump capacity LI S gpm Squirt Height � VI ft
Pump on time t4 4 Swc.Pn&s Pump off time L Ni-'S Daily flow set at r104 gpd
UpAatv.1 5.21_O l i
Mason County OSS Installation Report pg. 2 1'nrcol# 3 1g075��Z` /
ABANDONMENT RECORD
�were existing septic components abandoned as part of this project? - -- - _ YES C7 to)
If yes. please describe id k Q ee;t_• &AA , tN���' t5 _G!'!-.. -
Were all components pumped out and property abandoned per WAC248-272A•03007.- ei1
ES Ej
RECORD DRAWING
Ttws i'q permanent record and must he accurate and dasctipttve enough to re locate in the need of maintenance acthall s and tutu,*development r,rftAI Perm'
r114"Va c i*" Mhfleld a manttold arntalion$layout.Septib'pumr+tan*location,north arrow,Tan is drainfieki casting end prnpnwf t•rkfirqel rryatios of w+lla 'reared+es
weirs obteetvstton port*,eteanouts.and other mairuervrnor somas points Incomplete Record Drawings may create aNMirmal detain to anal v ta&tton approval arc,,etalM p••-
record Drawing Attached
CERTIFICATION OF INSTALLATION
- i
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
fo attaaNRecord Drawing is accurate. form and attached Record Drawing is accurate.
Signature of Installer Date • i . Itl I V/ C
•
Printed Name of Signee ' wn,, ^1
•
Q. 1
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and .. �1
•
Record Drawing on behalf of Mason County Public 5100347 V^
d . t Noumea Gala .%•
. Mn` a r c.
Health: c �: �..�
) ( 0ZI17i� 210
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 `r°"‘i w_':2°'
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CL rENI: OEB TC✓1MSEl0 tiREE00t LYE. LLC) •~:,� 1 " j4 N SYSTEMS LLC
12531 2}0-5202
2226 EASTLAKE AVE. SUITE 310 SEATTLE• WA. 96102 '�!= m