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HomeMy WebLinkAboutSWG2025-00300 - SWG As-Built - 1/15/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG �,%Z-S -- UO je'c.' Parcel# Z c 3 ( `f©C',c-A 0 Applicant Name J-/ON I 0 4. A-p4--1/" Subdivision (Name/Div/Block/Lot) Applicant Address hZO I 3 '•=i 4_,/c,_ 5(!J City, State, Zip Oly cN a of f Z— Installer Name Roy r-( C(115 t- Site Address2'3/ J \ AU'S i'T A Designer Name AD t 14 it t.A-If /1-__ INSTALLATION CHECKLIST ❑ Full System Installation Tank(s)Only O Drainfield Only O Repair ❑ Other System Type P;"e.Si 'r - - Pretreatment Type rv'z),L 1 >5 ft. from foundation? - O N/A .❑"YES O NO >50 ft. from wells? SM-\\.. .il. ❑ gi ❑ le >50 ft. from surface water? - __ ❑ ❑ ❑ < Cleanout between building and tank? - li - - �`%- 1 ❑ O _ N75 V Tank baffles present? - O IGY' O 1 Jam' a24"access risers over each compartme - - - - - _ _ _ O O W Effluent filter installed?- - _ _ __ O 'R( O N Septic tank size I Z 5 0 gal By Manufacturer Iw-i-k. �`-'_ 0 D-box water level and speed levelers used? ta— O YES ❑ NO O� Manifold/D-box accessible from surface?- ❑ ❑ O i r:1 Check valves installed? - ❑ _ O O 0< E Transport Line Size_ Schedule/Class Bedrooms installed (check one) O 2 O 3 12 .1 O 5 ❑6 O Commercial/Other >10 ft. from foundation? - ❑ NIA Y YES ❑ NO ® >100 ft.from wells?- - O ..� 0 W >100 ft. from surface water? - - O .g O ti >10 ft. from potable water lines?- Ett- crE ❑ > 5 ft. from property lines and easements?- > 30 ft.from downgradient curtain/foundation drains? - Drainfield level and observation ports present - - O , O O Graveless chambers or O Clean gravel used? (check one) _1-) Proper cover installed over drainfield? - 41,11L—' —' ❑ ❑ Pump tank setbacks consistant with septic tank?- - O N/A O YES ❑ NO Z Pump tank size gal Manufacturer < 24"access riser(s)and accessible from surface?- - O O ❑ I.- (1. Alarm or Control Panel Installed? - - - O 0 0 Control Panel equipped with Timer/ ETM/Cou - O O 0 a- Pump installed in ❑ Bucket or O On Block or ❑ Other a Pump Make/Model 0 Floats or 0 Transducer O=. Tank draw down in/min Pump capacity RI Hirt:Height ft Pump on time Pump off time Daily flow set at_ gpd i . x Updated 8121/201B MASON COUNTY ENVIRONMENTAL - J Bea. Mason County OSS Installation Report pg. 2 Parcel# )2O' 3 l'OC2 O / V ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - JA.YES 0 NO If yes, please describe: 5-C t f C Die A,K I " so ,z//c.,-,—c,-,�e_ Were all components pumped out and properly abandoned per WAC246-272A-0300? - - FLYES O 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. Draintield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. c � Z Y . r k y' PPI . LL JAN 1 5 2023 MASON COUNTY ENVIRONMENTAL HEALTH ❑ Record Drawing Attached JINN 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 1 further certify that all information contained on this I further certify that all information contained on this form nd a ache!,'ecord Drawing is accurate. form and attached Record Drawing is accurate. � /:Z-7.-Z5 , Sig 'fie o Installer Date ( ,---, /c-zf3,1-:‘-I Aa-r/1 - • Printed Name of Signe�� 7_,W :F, MASON COUNTY PUBLIC HEALTH ?•• The undersigned approves this Installation Report ands: �`s Record Drawing on behalf of Mason County Public t l LW.1 i? `.: ADAM HUNTER WU\A-46).—N 1 — I 6 -'2. ) Sig atu e f nvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated erzinoie Svc 25 ;V() Z 2_/ c7oO (v RECORD DRAWING (continued) 5 SCALE-1"=100' 0" — --—- - EXISTING STUBOUTI CL EgNOUT`� \ -FORCEMAIN TO DRAINFIELD I � --1250GAL.''ROTH 2-COMP.SEPTIC TANK(W/EFFLUENT FILTER) 3 `)I EXISTING 1000GAL.PUMP CHAMBER(RESEAL RISERS) j, `) FAILED SEPTIC TANK(ABANDONED PER CODE) / 1 PORC I I 1I I I 1 ` '! r�;•'' g(;..fir s-. tiluui,2__ oi, ADAM J.HUNTER 'y/ O ,I`N ,," ." ....AA PRESSURE TEST COMPLETED BY INSTALLER (• �� ur.l,y`11 \� SQUIRT HT: DRAWDOWN: ��P ' _SEED AIL !i" TIMER SETTINGS- BANK ON: OFF: Pl18ET SOUND JIM HUNTER&ASSOC. CONTRACTOR P.O.BOX 162,OLY,WA 98507 ROYAL FLUSH 753-1226 1HANDASSOCIAIE5®HOTMAIL.COM INSTALL DATE-9118/25 0 EXISTING RESIDENCES(TOTAL OF 4 BEDROOMS) O EXISTING DRIVE RECORD DRAWING SITE ADDRESS/LEGAL p p R 0 V ED 201207 E.AUSETH W a EXISTING WELL OWNER- LYNNE BROWN - FINAL DATE- 9/1525 O EXISTING BARN J AN 1 5 n TPM 32023.14-00010 SITE+? MASON COUNTY ENVIRONMENTAL HEALTH