HomeMy WebLinkAboutSWG2025-00138 - SWG As-Built - 11/5/2025 iik
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG a025--0013 S2 Parcel # 30Z.OoZ Z- 77- 90Oa.gz
Applicant Name J31// MGfwrnaJ Subdivision (Name/Div/Block/Lot)
Applicant Address Pa £nx 1.77$' �t
City, State, Zip (A✓449004 W4 9y5YS Installer Name ,rin rIVI,LV7
Site Address /t ?Ctrs/view 3A /i'p abr.,-1 0 Designer Name ',.-1 tt.r1 Gr-
INSTALLATION CHECKLIST
VI Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other
System Type Pr cAtie MDttnt,i Pretreatment Type
>5 ft.from foundation? - - ❑ N/A BYES [ o �_01
>50 ft.from wells? - 0 El [ -4 g
Z >50 ft.from surface water? - - 0 c
H Cleanout between building and tank? - - ❑ El f Z4
V Tank baffles present? - - ❑ El. o
d24" access risers over each compartment?- - ❑ 21.
W Effluent filter installed?- - 0 g Ca
Septic tank capacity(working) /ADO qal Manufacturer 1n)1)./Y7kkv/` L , , C, 'J
9 D-box water level and speed levelers used? - - IE,N!A ❑ YES ❑ NO
00 Manifold/D-box accessible from surface?- - ES CI
u.
mZ Check valves installed? - - 3 ❑ ❑
c a ,t y0
2 Transport Line Size � Schedule/Class
Bedrooms installed (check one) 0 2 E8 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ NIA ig YES ❑ NO
G >100 ft.from wells?- - 0 IS ❑
W >100 ft. from surface water? - - ❑ (S 0
ti >10 ft.from potable water lines?- - ❑ ®, ❑
.grZ > 5 ft.from property lines and easements?- - ❑ 21 El
d > 30 ft.from downgradient curtain/foundation drains? - - ❑ . 0
ca
Drainfield level and observation ports present - - ❑ tia ❑
❑ Graveless chambers or rii Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ V ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A YES ❑ NO
Pump tank capacity(flood) 41,00 gal Manufacturer '`
iesiyr-
< 24" access riser(s)and accessible from surface?- - 0 153 ❑
~
a Alarm or Control Panel Installed? - - 0 Z 0
2 Control Panel equipped with Timer/ETM/Counter- ❑ D$ 0
M
a Pump installed in ❑ Bucket or 10 On Block or ❑ Other
a. Pump Make/Model Z Oder /(.Z / ig-Floats or ❑ Transducer
R. Tank draw down y;L in/min Pump capacity 36 gpm Squirt Height a- ft
Pump on time /A7,n fa Set., Pump off time I1Atj Daily flow set at 360 qpd
Updated 8,21/201 B
I
Mason County OSS Installation Report pg. 2 Parcel# 3Z0 p '77- VOO �
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES ^/ a NO
If yes, please describe: �Y
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 4 ❑ 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. Drainfield&manifold orientation&layout,Septidpump tank location,North arrow.reserve drainfied,existing and proposed buildngs,location of wells,waterlines,
wells,observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
0 Record 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 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
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
••r ..s ,0,..),_4c t o}oj 2 c
.•'gna re o Installer Date J
T4� )10til ' I 0 -2�!.-LS"
Printed i�Jlle of Signee �
�Ph��+mod,wsrstiC�•4�
MASON COUNTY PUBLIC HEALTH 1,;
The undersigned approves this Installation Report and .<4. 'r<s
Record Drawing on behalf of Mason County Public p�•. IAMBI.HUNTER QHealth: Kiety< LICENSED DESK,NER
1E-s11�EXPIRES: 03/22
Signature of Enviro�Health Specialist Date (stamp, signature and date)
9
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121/201a
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