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HomeMy WebLinkAboutSWG2024-00002 - SWG As-Built - 12/4/2025 ( ( abm-S \ ")- ) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 202u- ObObt Parcel # 3 2 31 a- S1 - U t(}j tQ Applicant Name 80Cu. Oar r Subdivision (Name/Div/Block/Lot) Applicant Address PO 160x AU& City, State, Zip CO 1Opphv i IAAc/fl Installer Name thigkin Site Address ZNY. t 1.\ t.S141.,6a,4 W Designer Name Aeam Lk)nkr INSTALLATION CHECKLIST 4 ❑ Full System Installation 0 Tank(s)Only 0 Drainfield Only [ 2epair D Other System Type Ara) Pretreatment Type nuwater bnr1 500 >5 ft. from foundation? - • 0 NIA OYES ❑ NO >50 ft. from wells? - - - - 0 ❑ Z >50 ft. from surface water? - 11) MN �'- - - ❑ CQ 0 HCleanout between building and tank? J ' -NO Z -- ❑ ❑ U Tank baffles present? - 1L6 �02� - { - - ❑ 0 a24" access risers over each compartmint?- 0ID,_� - 0 Zi ❑ N Septic tank capacity (working) 1566 gal Manufacturer 1413 5 D-box water level and speed levelers used? - - 1Z N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - El El oil Check valves installed? - - 0 ® 0 GIQ 11 2 Transport Line Size 1,7.5 Schedule/Class SA 4 0 Bedrooms installed (check one) ❑ 2 ❑ 3 0 4 0 5 ❑6 Commercial/Other >10 ft. from foundation? - - ❑ N/A i YES ❑ NO O >100 ft. from wells?- - ❑ ❑ W >100 ft. from surface water? - - 0 0 tj,. >10 ft.from potable water lines?- - ❑ g 0 Z > 5 ft. from property lines and easements?- - 0 tit 0 Q 0 X > 30 ft.from downgradient curtain/foundation drains? - - 0 44 • Drainfield level and observation ports present - - 0 0 0 Graveless chambers or ❑ Clean gravel used? (check one) ^/A-Dc;.? Proper cover installed over drainfield?- - ❑ bP ❑ Pump tank setbacks consistent with septic tank? - - 0 N/A YES ElNO • Pump tank capacity (flood) ISU x2 1 gal:3ocC Manufacturer l 12, pre Cad+ Z El ® El 24" access riser(s) and accessible from surface?- - ~ a Alarm or Control Panel Installed? - - ❑ ® 0 E Control Panel equipped with Timer/ ETM /Counter- - 0 kg 0 m d Pump installed in ❑ Bucket or ((��-On Block or El Other a• Pump Make/Model Q(Q,X �C -7.-U0 t . litloats or ❑ Transducer CL a Tank draw down in/min Pump capacity $O gpm Squirt Height MA- ft Pump on time ,Y►' Pump off time 2 hours Daily flow set at 1206 qpd Updated 82120'8 Mason'County OSS Installation Report pg. 2 Parcel# �7 c)) 61,� ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ® YES 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,Septcipump tank location.North arrow reserve drainheld.existng and proposed build ngs,locaton of wells.waterlines. veils,observation ports,cleanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. ® 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. rYC4, rIk\'\\c‘) Sig ature of Installer Date c106-- ff0v)r 11/2 /25 Printed Name of Signee { 3� • tS? MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public „�,W.MAT 4R Health: 1,$testy 71 (- Signature of Environmen I Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8,21'2018 +irnmmw -00000000000 wir )-------___ N N x1 N 0 x > N m X tr p OCnr0 -- 0rA Z0 _ 73 m O r Z AO -' 7` IA 0 r p1 > N _ r T ' ;n N C M Z D 7\ W N II C m Cl) m 03 C C cn C) m mO y DCy -1 713 N • o ZO I ! ! m Z• m v0 *-� ZDn+ Z A m NZ T m F - m m o Z c) _co § Ali --------------.--_.--____-_____,L_________-_-_,..____ ••••_..............ii v N m < 0 m w c -x 5-Nco, _ 1 O m - i�lD z _ 8 t D • 5: W c. o cn _ � O old, ;T_-__ 03 m v O z / wile. 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