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HomeMy WebLinkAboutSWG2025-00213 - SWG As-Built - 12/10/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2025-00213 Parcel# 519451-03001 Applicant Name ,,k)HN GLASER Subdivision (Name/Div/Block/Lot) Applicant Address V432 OCOUNTRY RD 15 City, State, Zip NAPOLEON, CA. 43545 Installer Name 1-09q✓t. 5ptar Site Address Co`co vJ Wst—t-F, ,, fL. ?4 Designer Name G-1r1a. V1/4faC l-}-C-- INSTALLATION CHECKLIST it Full System Installation ❑Tank(s)Only 0 Drainfield 0 Repair ❑Other System Type SAND LINED PRESS tment Type >5 ft.from foundation? - 1 0 WA ®YES ❑ NO >50 ft. from wells? - 0- ___ 10- 1 _ 0 NI>50 ft.from surface % 0 Z water? i ,� � la ❑ < Cleanout between building and tank? ---1, ---- - _ ® ❑ tl— U Tank baffles present? - _ __ _ _ _ _ ___- ❑ ® ❑ 24"access risers over each compartment? 1-. _ ❑ ® ❑ W Effluent filter installed?- ❑ EV 0 co Septic tank capacity(working) k<I,2404 gal Manufacturer ..sntmu[ pfaGeate - S D-box water level and speed k velers used? - - Ei N/A ❑ YES 0 NO •gO Manifold/D-box accessible from surface?.t - 0 ig ❑ Check valves installed? - 4/t - El ❑ a Transport Line Size 2 Schedule/Class SCHEDULE 40 Bedrooms installed (check one) El 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ WA ® YES ❑ No G >100 ft.from wells?- - ❑ El ❑ W >100 ft. from surface water?- - El © 0 u. >10 ft.from potable water lines?- - 0 0 ❑ Z > 5 ft.from property lines and easements? 0 II 0 a >30 ft. from downgradient curtain/foundation drains?- 0 0 Drainfield level and observation ports present - - El El 0 Graveless chambers or pi Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ® 0 Pump tank setbacks consistent with septic tank? - - 0 N/A IN YES ❑ NO NC Z Pump tank capacity(flood) :!,2c O gal ! Manufacturer ! - cocoifla re� N24"access riser(s)and accessible from surface?- 0 Nil I— a. Alarm or Control Pare! Installer!? - - 0 4 ❑ Control Panel equipped with Timer/ETM/Counter- - 0 ® 0 a- Jump installed in NI Bucket or 0 On Block or ❑ Other a' Pump Make/Model K Li,e� .03'! Floats or 3. J El �� R., Tank draw down I..5 in/min Pump capacity 37,JQ qpm Squirt Height ) 215 ft Pump on time (L4 2, 0/obi Pump off time ' Daily flow set at I 6 Q qpd Updated 8/21/2018 7 Z se-co.rr,• Mason County OSS Installation Report pg. 2 Parcel# 5190-51-03001 ABANDONMENT RECORD Were existing septic components abandoned as art of ns project? - - ,1.-1 YES 0 NO If yes, please describe: P��. and ‘,/ Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ri 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: Draintald 8 manifold orientation 8 layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cieanouls,er.d 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/installed the system in accordance with I certify that the system has been installed in accor- the septic design stam,;ed 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 hem 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. 12/4/2� Si 4f4tti of lnst ler Date L e4 sari 509 ea of. :4' 11 a Printed Name(of Signee 04 ASti, 9� MASON COUNTY PUBLIC HEALTH s��� ' v_ % '� Y ti. The undersigned approves this Installation Report and •5 448• .t. F e ._ AND E WAITS Record Drawing on behalf of Mason County Public LICENSED DESIGNER Health:@1I • _, ri t t,O/ EXIhFti.S 05+0 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 updated emrzote d 22 31 s D w0 m e 0 r.:a p.J.. 0 a co 0 i pEC 10 2025 �tt� f.��_-- al x- co ��" vORONMEl k\- A Xi MASON COON a E� --- - co .%' \ \\\ I .-' , Q N to li °I II ; 1t ! : _e__t__-______rn --s - -t 0. 0 ab... .ftt ti tlika IL-1 — La ;r4 ;i, p 4- 4: 0-4 . o " g r N a `' C� co s #�. +` r. . w D• O ;A • N _, �"y .K �p :Z7 CD Q AI O CD g N N O k C rn I t -el P 'O O OQ su x 6` n tab tn• c .0 a) 'ta/ vco g .Q 9 � =+ a to N (ADS Ei p 4. ,`S a �p C0 co 1 f,• Q. _• J 3 = irrr 5 m,, 1'9S to I i• t2., S�AITFh'S• p R J ��m>.4 ilkn.5 y O° No ` 1 z .s 0) ^ t ikti .,_ 313