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HomeMy WebLinkAboutSWG2023-00407 - SWG Application / As-Built - 12/3/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG Parcel# 3-y?/4!a4// 9aO 242 Subdivisionock/Lot Applicant Name �,rf� /�,Gi.S'� (Name/Div/Block/Lot) t � Applicant Address 7 7 q.v.., di% Sr: -Pro 1-, /9'1312.7 City, State, Zip C4 eA4�o.' Aid yeriallstaller Name 49464/ d oes4C Site Address w /? /� I /o . ,Designer Name C//,1Ys ae..-.5T/egDosii` INSTALLATION CHECKLIST ull System Installation 0 Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other System Type d ^ dov/T7- Pretreatment Type >5 ft.from foundation? - f - ❑ N/A 0 NO >50 ft.from wells? - - 0 ®^—� 0 X >50 ft.from surface water? - -- ElL ❑ • Cleanout between building and tank? - ❑ l� 0 O Tank baffles present? - - 0 ®,__,� 0 I F- 24"access risers over each compartment?- - 0 E^K� ❑ L�SI Effluent filter installed?- - 0 I=1t' 0 co Septic tank capacity (working) //re gal Manufacturer 4;/ey 5ff in D-box water level and speed levelers used? - - ❑ N/A arts ❑ N° 0O Manifold/D-box accessible from surface?- - 0 0 C4z Check valves installed? - -- El oQ � 3 I 2 Transport Line Size 7 Schedule/Class � Bedrooms installed (check one) L`T( 0 3 ❑4 0 5 ❑s ❑Commercial/Other >10 ft.from foundation?- -- ❑ N/A ,_, es 0 NO Ct >100 ft.from wells?- - 0 L.. 0 W >100 ft.from surface water? - - 0 El' ID IT. >10 ft.from potable water lines?- - 0 ! 0 2• >5 ft.from property lines and easements?- - 0 0 ii >30 ft.from downgradient curtain/foundation drains?- - ®-'9 " ❑ ❑ CI Drain level and observation ports present - - ❑ [{ '' 0 raveiess chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 0 Pump tank setbacks consistent with septic tank?- - 0 N/A ❑ YES _____I l-No Y Pump "v flood) gal Manufacturer _,------- F24"access riser(s)and acc 55 1 surface?- - El 0 Q Alarm or Control Panel Installed? - - ❑ ❑ 0 2 Control Panel equipped with Timer/ET ounter- 0 ❑ , M 1L Pump installed in ❑ Bucker-or 0 On Block or ❑ Other rump nnnke,/ 1 0 Floats or 0 Transducv a T raw down in/min Pump capacity qpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8121/2018 Mason County OSS Installation Report pg. 2 Parcel# S1714' —Vi— d'QO ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES Ergr If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 4/0/1 NO RECORD DRAWING Thls Is a permanent record and must be accurate and descriptive enough to re-locate In the need of matntanance activities and future development Typical Record Drawings contain: Drainfield&mandold onentation&layout.Septic/pump tank location.North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines. weHs,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and rotated permits. tx."0 do,t 5, t - forlIC ecord 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 informatio41 ntained on this /further certify that all information contained on this form and attache• ' o g is accurate. form and attached Record Drawing is accurate. Signature of Installer DateWoitit • .tea �cGss�ll Printed Name of Signee t e i e-: C* max. MASON COUNTY PUBLIC HEALTH r 4 fx� f{� The undersigned approves this Installation Report and • s41° "'-E' 0 N��4v°_ Record Drawing on behalf of Mason County Public , Health: A -"- QII\jjed\12(91/ le-eA /2 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 812112°18 i / . 0� / 7 • - - / Ra ^ I y n +i o s./o' O. > n 2� 3 I 46 414; ., ` �1 i 62. - • 'C.tg j/ 31 ... ot) V \* u. 1 '2' \ CP N G 4,, L 15; 4' a ,\ G NO > a © < n m h y:$ \ice- .8 , m o �� 8 w m u N9/ (" G'i' rTi Z t 1 - , lki -r.. k o• l % o • A.-- \r � s Nex N. ......4 1\ w 1:_____ ' ki A a a -- - w . Gr>/Vi7�UL 6�JFrlS�� .___ VI N.za Z so.Gp" /S-f. 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