HomeMy WebLinkAboutSWG2024-00071 - SWG As-Built - 11/5/2025 •
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number • SWG Z02•44— > 7/ Parcel # 72.61(4--51 060 I(4,
Zjfet Applicant Name1refr-e/ Subdivision (Name/Div/Block/Lot)
Applicant Address -(hac '-14%.1
City, State, Zip � t6 ,CA 913o1 Installer Name Tttkd u, - (�,1-A
~ Site Address 3Z I N . 405 c'I Designer Name (.' �,D� 1)(,�,t,�'`��{-���
t U
. v
44 ; INSTALLATION CHECKLIST
.1" ...e4Full System Ihstaltation 0 Tank(s)Only Drainfield Only�t ❑Repair 0 Other
System Type ALON C 4 IC�itie- (52 (ent Type
�Q l'
>5 ft.from foundation? - n. I ❑ N/A WYES ❑ NO
>50 ft. from wells? -- - - -- - - - - 1 %
��
>50 ft,from - ❑ ❑
Z surface water? - - 45 ❑ ❑
4 Cleanout between building and tank? - • Kt- �- ❑ ❑
0 Tank baffles present? - / - ..01 - - - - - C-1 0
a 24"access risers over each compartme'tev- -bk. - - - - 0 E.]N LU Effluent filter installed?- - - - _ - fl a.
Septic tank capacity (working) 4�Z� gal Manufacturer Skc.l ?6c.Gw i1r-
�O D-box water level and speed levelers used? - - J N/A YES ❑ NO
RO Manifold/D-box accessible from surface?- -• _ -. -_ •- - 7
GaCheck valves installed? - -. , 0
a Transport Line Size y
P Z SchtdWe';siass 910
Bedrooms installed (check one) A' 2 0 3 0 4 ❑ 5 i D E IJ Commercial/Other
>10 ft. from foundation? •- -- . ❑ N/A YES ❑ NO
G >100 ft. from wells?- - - - - . —
❑ 0
W >100 ft. from surface water? _ - -. • 0 D
iI >10 ft.from potable water lines?- - 0 0 .,
4 >5 ft.from property lines andieasements?- 0 0
Q > 30 ft.from downgradient curtain/foundation drains? -•-• - 0 0
Drainfield level and observation ports present - - - - = - - ❑ 0
0 Graveless chambers or .12I Clean gravel used? (check ons)
Proper cover installed over drainfield?- -. . - _ - . ❑ a ❑
i �p,,�
Pump tank setbacks consistent with septic tank? - ,- fsi - 0 N/A 'YES 0 NO
ZPump tank capacity (flood) gal M8n4fac:urer1rL�
< 24"access riser(s)and accessible from surfac ? .K 0 0
Alarm or Control Panel Install'd? - - - - - 0 0
Control Panel equipped with Timer/ETM/Counter- -- - ❑ ❑ V
a Pump installed in 0 Bucket or 0 On Block or ❑ Other
Pump Make/Model kJ -2- ZdI� loats or 0 Transducer
a. Tank draw down i in/min Pump capaci.
O- ,,�,,,, 'y_ "pm Squirt Height ft
Pump on time j �� tiff ti;, e
Pump Daily flow set at gpd
Jpdated 8.2'!20'8
ANL
Mason County OSS tnata!I tion Report pg. 2 Parcel r22-4104' ' 51 ' OCR IS.
iABANDONMENT RECORD
Were existing septic components apanaonee as oars of thk project'. - - -- - - le YES 'NO
If yes, please descli:ie: " • • •
Were all components pumped out arid properly abandoned per WAC246-272A-C3C0? - le YES El NO
f
•
I RECORD DRAWING
Y
This is a permanent record and must be accurate and descriptive enougn to re-locate in the need of malr.terranre.activities and future development. Typical Recoru
Drawings contain: Drainfeld&mandold orentattor d,layout.Sept.,_,pump tans location.North arrow,reserve drainfeid.existing and proposed D,:ildings.location of wells,µatenires.
wells.ooservalton ports.clem'orts.anc other mai.tEnonne ac.ess po ar incomplete Record Drawings ma create accitiena:aelays in final installation approval and related permits.
•
)11/45 P& . Den 14.
•
•
Cr5
."Record Drawing Attached
CERTIFICATION OF INSTALLATION -
II
INSTALLER 1 DES./t;NER ENGitvEER
I certify that 1 installed the syste in accordance with I ,z.',rify that'he system has been installed in accor-
the septic design stamped APP OVED"by Mason ci ncS Wei the septic design stamped'APPROVED"by
County Public Health and that an deviations shown Mas m (.ou.ii, ublrc Health and that any deviations
here have been cleared/approved by both the designer shoat:!Jere t:wB teen clearediapproved by both ..
and Mason County Public Health and meet all State I ruse,"ai rd Meson County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this .'rut•-her certify that all information contained on this
form and attached Record Drawirrg is acct.rate. farm and,attacaed Record Drawing is accurate. -•
Q- 1n i 5 '
Sign f Installer i`4 to m. __ .��'.
�� .4 a
•
Printed Name of Signee ,!,��u,0 -,.4, ,,fib
MASON COUNTY PUBLIC i-IEA TH •' '�' ��!
The undersigned approves this In reflation Report am -''•• c st„ ei �`ttl
Record Drawing on beralt of twos, n County Public ,! LIEN _• `ESIGN�FR • it,
1 Health: 1 ISW
E%FIRES US 10
011
Signature of Environ ntai Health Specialist Oats 7 (srarrpt signature and date)
THIS FORUM MAY BE.SC MINED ANC AVAk_A =FOR Pt,BL.,:•V!EW OP.?hE MASON COUNTY WEB SITE ipaeted"Ill"'
.
! ' ' ."•• - - , • ...
. . ....
• .. %
..
•
I I ts, . • . •
j . : ',.. '--.A At ..x.cibW-4 .'. .'•-1-. - ' ' . ,,. ., ,ii.orittie%s L., ..,..' -' .. , . .- ....'.11'..',....,
•••••.,...
-..
: ,..,,,... .:,., .* ...7..••••. , • ,!. s..... •...k.., It.i..:.,:,3,...k '',V...,.) ..,.. . .. r
... • . • • ' :- • • 1.•'' • • ••`..e • • i ' +V i",i,'I'' le.i. -".',...• '''• :'"'
1 2
T....
,...0,.../- -, . ...4
...,
y -.
u kfl. Ai 0'4
i E ..... e 0 41480 tfr eb ,..,
....„,tc o - ....&. .....,z0.17 gi z ,o5ar
CO g .- -4= 7,,-
To - ° "t i i
.„ 0,4 2025
. a 1... 4 ,z
. _ t 8 : ,iroi
/.1.E.7. ...,yi.,4 1..,
I 0 st c 700 ,- ,., /4-,,.
0 . z nexiz k qk :
,
„
it, : - :
i = Icia. ,..,aimc
112 :3 SE -5x E E4 41 .
I
4
th
1. 1._.
. 1 ,v t•r. --- ----------------- N,
1 4 tt
....,,
..,.
1' till 202'1a°1?
1/
t .
SI-
—-
k 6.0t
at,
i
Ls' 1 _.
S. .
Nr. ,
$ .
at 1 .•
.
....
, •
• ,,,
4 f
f 1"
.. .,..,. # ,
.... 14'.
010 0.
Pif:31;?0 poor
•-:' . , E.WA/7E
V
1.1castio otamee 44, ifi ,... CY g
...1%.,.............."..........‘.... ..., 1.12*e. ..0. ..-- .07
E i.IV
6'10 41
i in i v
cool)), .7 20,47s Wgg 'g ! i IL IL 1 t
1 E./ViVi.
I); 04,4iiii
u-N% , 0 c.;.•
iPrinted From Mason County u -1.J ...,„4 ..,.4.4 i Q
4 ifE /IV .":31..! :-: 0 tot,
1-
,1•
- County
..%.,, Printed fft3M Mason DMS 7.1
' ._