HomeMy WebLinkAboutSWG2025-00392 - SWG As-Built - 12/5/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
I APPLICANT! PERMIT INFORMATION
Permit Number SWG 202.5-CO5iL Parcel# 3LY 34 -75 •-c)o'/ 'l
Applicant Name C* c1. Subdivision (Name/Div/Block/Lot)
Applicant Address o w 1.1. Sc-flei icivr w
City, State, Zip Ill h,N&bp,wA 9$sSS Installer Name '"'7r4D Sr`T��A*e•-
• Site Address o1cb ^4 `.mill'IVY" t.0.1 Designer Name crrkkl Wir
INSTALLATION CHECKLIST
befFull System rnstaHati ;1 [- ,TTank(s)Oniy 0 Drain iei, Oniy ❑Repair 0 Other
System Type ,� '�""�"1 *-b&') Pretreatment Type
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>5 ft.from foundation? - i — — — — - ❑ N/A KYES 0 NO
>50 ft. from wells? - - - - - t - - - --. %� ❑ ❑
Z >50 ft,from surface water'? -1 \ap �g 9 `ll ❑ � ❑
H Cieanout between building and tank? -i:, ,vu, 1.5-2)1 . - - ❑ 0
V Tank baffles present? 1 -I t _ _ _
11.1 24"access risers over each t ompartment6. _ (9 ❑
W Effluent filter installed?-
N Septic tank capacity(working) /•Z-�t� gal Mar.ufacturei InZir iL - tZ 0
9 D-box water level and speed levelers used? . - [] N/A BYES ❑ NO
�O Manifold/D-box accessible from surface?- - - -- •. . ❑ 1g ❑
c9 Z Check valves installed? - 0 0
c:12 Transport Line Size 4/ 41 Schedule/Class 3°3 y
i
i Bedrooms installed (check one) 0 2 0 3 8r4 0 5 ❑6 0 Commercial/Other
>10 ft. from foundation?- - -- ❑ N/A '0,1 YES ❑ NO
C3 >100 ft. from wells?- - - . +❑ :4 0
w >100 ft. from surface water? -• - • n r. Et
ti >10 ft.from potable water lines?- - -- 0 ►.! ❑ .'
Z >5 ft. from property lines and easements?. 0
> 30 ft.from downgradient cu'tain/foundation drains?• . ❑ 0
Drainfield level and observation ports present - - - - - - - 0 i 0
❑ Graveless chambers or 141 Clean gravel used? (check one)
Proper cover installed over drtainfield?- - 7 / in ❑
Pump tank setbacks consistent 'th septic tank? - -• - �,; --r
� S ❑ YE3 ❑ NO
'
Pump tank capacity(flood) I I Manufacturer E
< 24"access riser(s)and accessible from su a '? - - - - - ❑ ❑
1-
0. Alarm or Control Panel Installed? • -- - - - - - - C ❑ 0
Control Panel equipped with'Timer/ETM/Counter- - - - - - • ,nI 0 0
a Pump installed in ❑ Bucket, or ❑ On B or ❑ Oth .a.
2 Pump Make/Model 1
i oats or ❑ Transducer 1-1
d Tank draw down '; in/min Pump capacity .;prr, Squirt Height ft ' -
Pump on time � 1 Pump off time Daily flow set at gpd
Upr.4:ee e.21'2C'..
Mason County OSS Installation Report pg. 2 Parce;# 2LI 3y- 75/D ic:/f
__ ABANDONMENT RECORD
Were existing septic components abandoned as part of tni. project? - - - - . N YES ED NO
If yes, please describe:
Were all components pumped out alit properly abandoned per WAC246-2;2A-0300? • - 'YES [] NO
j ..
T RECORD DRAWING
This Is a permanent record and must be actuate ana descriptive enough to re-locate In the need of maintenance activities and future development. Typical Recora
Drawings contair: Drainfield&n.nifo:d orentat+ce&iayo:.t.Septioni.rr.p taro incat:nn None arrow,reserve ora nfetd.nadir,am proposed r;,ildings,location of wells.waterlines.
wells.observation ports,dearovts.and otoer main enanee access points. incomo:ete Record Okaw:ngs may create additional ee!ays in final installation approval and relater:permits
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'S4 Record Drawing Attached •
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CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ Er CINEER
I certify that 1 installed the systf: .,:n accorde,nce with I certify that the system has been installed in accor-
the septic design stamped'AP l ROVED"by Mason canoe with the septic design stamped"APPROVED"by
County Public Health and that doy deviations shown i Mason County Public Health and that any deviations
here have been cleared/approv d by both the designer shcmin here:Tara peen cleared/approved by both.
and Mason County Public Health and meet all StarE: I myself and Mason County Public Health and meet all .,
and Mason County Cones. i Sta:e and Mason County Codes
1 further certify that all infcrmatiun contained en, thi t !turner csrtiiy the'all,n ormati.n contained on this
form and attached P.eccrd Grading Is a�n•,>'��. :orrn;rlo uit3Ch9J:-ceccro Drawing is accurate.
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Printed Name of Signer ...•0 r•►', �t . I
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MASON COUNTY PUBLIC HE LTH 1!_ n� "s!'- ��
The undersigned approves this r'stwliation Report :rt.' I '40 Y E r0 ITE' t►
I Record Drawing on behalf of M s'_n Court/Pub::" . r.•'• LICENSED DESIG )�` • ,
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I Health: EXPIRES t01
11Z11\9}Aryi941:. 17/(S-12-c
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Signature of Environmental 1-1e9tbn�)JCiAiist DNty • c (stamp, signature and date) f
. J THIS FORM MAY BE SCANNED ANC I. ... .._.: "c;i<rlJ.i:IC ,E.YY 0:1 TIDE MA:iCN COUNTY WEB SITE urrar'.trc er2tao18
RECORD DRAWING tcontinued
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DEC 0 5 2025
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