HomeMy WebLinkAboutSWG2025-00195 - SWG As-Built - 3/9/2026 w •
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Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2,e/gS^L�r1 11S`� Parcel# �Z c.,;15 4,•-S?) --c)l0 7
Applicant Name 1Idd l!I e4Wt .qt,�(M/t a-- Subdivision(Name/Div/Block/Lot) f4t=LD kk
Applicant Address P:61,-..5c7-' :c.26\1,..11 , -
City, State,Zip `.etivuutei... A- 9 k pp' Installer Name jtW.L- Nlc l�M.'V—
Site Address I 13 F 15(604. tee,ii Designer Name •, atv c $ t-vt,.y-t- ",e__.)
- • - I.STALLATR N.C.HECKL:IST . - .
1g Full System Installation ❑Tank(s)Only ❑Dralnfleld Only 0 Repair ❑Other •
System Type Pretreatment Type
>5 ft.from foundation? - f f---- 0 NIA RYES 0 NO
>50 ft.;::::water?
4V--- ❑>50 ft,
< Cleanout between building and to r ' \'` -
o Tank baffles present? - a;-IAA -- 0 Er 0
024"access risers over each compa #1?----- - - -- _\ ElEl ❑
tW Effluent filter Installed?-------- -
-.7-f---_---- 0 0 . -
Septic tank size (7,40l1�0 ga ‘- nufacturer 5N Y13.: -',
.o D-box water level and speed levelers used? - - El N/A YES N/A It.
NO
O. Manifold/D-box accessible from surface?- - 0 gl 0
92 Check valves installed? - - 0 0
oQ {t
Transport Line Size 2.. Schedule/Class
'zit() •
Bedrooms Installed(check one) 0 2 C -3 Or ❑5 06 ❑CommercialOther
>10 ft.from foundation?- - ❑ NIA ,r YES 0 NO
® >100 ft.from wells?- - 0 121
W >100 ft.from surface water?- - 0 El0
i. >10 ft.from potable water lines?- - 0 13 0
>5 ft.from property lines and easements?. - 0 ❑ 0
>30 ft.from downgradient curtain/foundatIon drains?- - 0 E 0 .
o
Drainfield level and observation ports present - - 0 $ 0
,0 Graveless chambers or 0 Clean gravel used? (check one)
Proper cover Installed over drainfield?- - 0 t ❑
Pump tank setbacks consistent with septic tank?- - 0 N/A Cif YES 0 NO
he Pump tank size 14®0 gal Manufacturer .c5AiYi):.--'.¢
< 24"access riser(s)and accessible from surface?- - 0 E' O •
a.- Alarm or Control Panel Installed? - - 0 K4 0
• Control Panel equipped with Timer/ETM/Counter- - 0 1.1 0
p- Pump installed in 0 Bucket or 0 On Block or 0 Other
mPump Make/Model 7.445--Z4....5,-2. ►, Floats or 0 Transduo '
R., Tank draw down Q3 `. in/min Pump capacity ,(110 qpm Squirt Height �6// °f
Pump on time 6 Mi4 Pump off time hi"- Daily flow set at —DPI_
Updated aa'lNiii
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Mason County OSS Installation Report pg. 2 Parcel ft 32-00 r 5Z.e- e) t O`t
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - '`= YES O NO
If yes,please describe: i' ! 669 ,(r is Ui-!LG ri<� 'r;,„4.4/c, -:` D,
Were all components pumped out and properly abandoned per WAC246-272A-0300?- - ig YES O No
RECORD'DRAWING
This Is a psrmanent record and must ha accurate and descriptive enough to re-locate in the need of maintenance activities and future davelopment Typical Record
Drawings contain:Drainfiald&manifold orientation&layout,Septlet ump tank location,North arrow,reserve drelnfleid,existing and proposed buildings,location of wells,waterlines,
wells,observation ports,eleenouta,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
LRecord Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER .
I certify that I installed the system in accordance with /certify that the system has been Installed in eccor-
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 attac, d Record Drawing is accurate. form and attached Record Drawing is accurate.
--ft._- 7/i S/.05— .
Signs re of Installer ! Date *t
Wi IitAiR R AAc.---Ti l,z,\1 �3 ,� -.2--2—C.Printed Name of Sfgnee �� W r.,,,,,, s 1
MASON COUNTY PUBLIC HEALTH ,g,- - ,f,•-. �
The undersigned approves this Installation LI3 ;_a `• ;,A,;r3 s�
Record Drawing on behalf of Mason County Pub is h ((,)1A-.,,61,,-(o''_ )At,;' S I II t •
Health:.1(2._.,
`, UC 4SlC/f�fSlrj{\fcR
3/777(,) N BAR 0926 FbtS: 03/22/2.6
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Signature of Environmental Health Specialist d eE.NVIR� •
((stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAiLA6L FOR PU 'I'_My,/ON THE MASON COUNTY WEB SITE Updated 812112010
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MAS®NCOUN�ENVik�,. o, _ IAMB A KtiNTER _ P.O, BOX 162 OLY, WA 98507 �`L.,L.
LICENCM DESIGNER A.A.C��4JCr - �rZ�-'L5
DJA TN5r'P.LL bATE
� �_�,i:S�_l_ _ 753-7..26
EXi:RKS: 03/22/
RECORD DRAWING SMTE ADDRPSSjLEGAL
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