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HomeMy WebLinkAboutSWG2023-00377 - SWG As-Built - 12/19/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 01,O 3'3 --00 3--- 7 Parcel# i ( Gj (`7 -6(-0 0 Oo1c Applicant Name Sh ea_ \r )cL\ \cex Subdivision (Name/Div/Block/Lot) Applicant Address ,`j(--r f �� 12.7 1"-h L_v<.. lt) City, State, Zip g 0r-�}e �-�e_v-, vJl�-�[d'6 rtef Installer Name ( \ct'\ . GOl c\( Site Address ....1 C n 'e PL r w,«.- Designer Name . j vv\ (-\ ct r INSTALLATION CHECKLIST g Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type , . f s C---- ` retreatment Type >5 ft. from foundation? - ti lrj -�- /JT N/A Q YES ❑ NO >50 ft.from wells? - 0 ❑ • >50 ft.from surface water? - 1 -DEC-1 6 2i325_- El ❑ ❑ Z Q Cleanout between building and tank? - CI CI o Tank baffles present? - By - - - - - - -- ❑ ® El a 24"access risers over each compartment ---- - - - --- ❑ © ❑ LU Effluent filter installed?- - ❑ 0 CI Septic tank size eA,srttic -- cal p yl Manufacturer v.iSr,NG 0 D-box water level and speed levelers used? - - El N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - CI El CI mZ Check valves installed? - - ❑ . l ❑ oa 2 Transport Line Size I Schedule/Class_ yo Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A .J YES ❑ NO >100 ft.from wells?- -- - ❑ ® El o W >100 ft.from surface water? - CI 0 CI u.. >10 ft.from potable water lines? ❑ ® ❑ > 5 ft. from property lines and easements?- - ❑ ® ❑ >30 ft.from downgradient curtain/foundation drains?- - CI ® ❑ Drainfield level and observation ports present - -- - - -- ❑ © ❑ ❑ Graveless chambers or El- Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistant with septic tank? - ❑ N/A © YES ❑ NO • Pump tank size lb 60 gal Manufacturer INF,L-r r-hn-,.M- • 24"access riser(s)and accessible from surface?- - - -- -- - - - - - -- -- ❑ © ❑ ~ Alarm or Control Panel Installed? - - ❑ 1=1 ❑ tL E Control Panel equipped with Timer/ETM/Counter- - ❑ gill ❑ D n- Pump installed in ❑ Bucket or On Block or ❑ Other 0' Pump Make/Model ?_o&i..t..Eit- t J t d'L © Floats or ❑ Transducer eL Tank draw down j,6 in/min Pump capacity H 0 gpm Squirt Height /(, ft Pump on time 4 Nit./ Pump off time .46..44.4-L -ir.S Daily flow set at ti`-1b qpd Updatad 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# S lel l-I - fl -bouvB ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - 0 YES ® No If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES I� �. 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. Drainfleld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve dralnfleld,existing and proposed buildings,location of wells.waterlines, v;ells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. r \fc--1-}b S -J ; l, ®'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 an. attached Record Drawing is accurate. form and attached Reco r i u t . Sig o Installer Date \ kv_E Go..v Printed Name of Si nee 4. MASON COUNTY PUBLIC HEALTH y\�- 51002/3 sJ�. The undersigned approves this Installation Report and O ::::::::ERRecord Drawing on behalf of Mason County Public t.l NER - SI.Health: �tZCv cp- k.?,, lct tic- 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 Urdated 8l21f2018 1 •. • 2 r3 1 JI 0 w '3- u i : U n N i Illg Q d 33 • t i 7•N o ,, s I- 0 r w Z ^ n g T n u • e H a a I` n �V1RONMENSALHEA. MASON C0°"Et RES .. 4, • 3 1M T. � Ial �2'4 -1tAl VI I•o' •g1Id der Aoi 01 j -i: 1 '--7.: f Nd i+ tS_i pt s m J N 4j a i. I j \•,` m AI 1 a n1 e , I i I ,��. ,k •Mill t yyl�j • 6 J' 7 u►