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HomeMy WebLinkAboutSWG2026-00028 - SWG As-Built - 3/30/2026 •o r Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWGZ UOO2 > Parcel# S i 7 0 510 ®�9 c Applicant Name IC,'A-; . -r1 Qr L (s19 t-AN Ofet ubdivision (Name/Div/Block/Lot) Applicant Address 2Z Z`f City, State, Zip c tVi1 9 ')7 Installer Name Rl7 4 I , p Site Address 2.ZZ \ S TAI" x it vi Designer Name INSTALLATION CHECKLIST ❑ Full System Installation ITank(s)Only Dral fly /Repair ❑Other System Type d i''A i retreatment Type /V©&i >5 ft.from foundation? ------------ - - -_( ').ç- ❑NIA OYES O NO >50ft.from wells? --------------4 --- ❑ >50ft.from surface water? ---------- ----�- - ❑ Cleanout between building and tank? -s$-- - - -- ❑ ❑ V Tank baffles present? ------------------ --- r ❑ a24"access risers over each compartment?----------- 0 ❑ W Effluent filter installed?--------------------- ---- ❑ ❑ N Septic tank size al Manufacturer I/ KPQLAJ'\ lyA 0 D-box water level and speed levelers used? --------------- ❑ NIA ❑YES ❑ NO DO Manifold/D-box accessible from surface?-- ---- 0 ❑ ❑ lnz Check valves installed? -------------"------' -'--.-- -- ❑ ❑ ❑ 5 Transport Line Size Schedule/Class 'eX 5i_ / Bedrooms installed(check one) ❑ 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft.from foundation?-------------------------- ❑ N►A ❑YES ❑ NO >100ft.from wells?----------------------------- ❑ 0 ❑ W >100ft.fromsurfacewater? ------------------------ ❑ ❑ ❑ u. >I0 ft.from potable water lines?--------- ❑ ❑ ❑ >5 ft.from roe lines and easements?------- ❑ ❑ ------ q t•: GG >30 ft.from downgradient curtain/foundation drains' - 1 0 Drainfield level and observation ports present ----1-L ------ iJj or Cleangravel used eckne ' 11 ❑ ❑ ❑ Graveless chambers ❑ � (W, ') Proper cover installed over drainfield?-------- S-3 e{:JN t'€ i4R01 uvi-NTAL HEALTH ❑ ❑ Pump tank setbacks consistent with septic tank?-------------- 0 NIA YES 0 No Pump tank size 410 gal . Manufacturer i11 l LY7 / I-o8^ 7tA 5-£Fv Q24"access riser(s)and accessible from surface?------------- ❑ ❑ O~. Alarm orGers' o eHnstalled? ---------------- ----- ❑' ❑ Control Panel equipped with Timer/ETM/Counter----------- 9L Pump installed in 0 Bucket or $,On Block or ❑ O er a Pump Make/Model �..r�"(Ii i &(V'1ay loafs or° ❑Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8212o18 h .t Mason County OSS Installation Report pg. 2 Parcel# S Igo 5 f o o is C - ABANDONMENT RECORD Were existing septic components abandoneI as art of this pr 'ect? - ------ OYEs NO if yes, please describe: I.C.K e..rA r" ,. )I Q�'\- - l� Were all components pumped out and properly aband ned per WAC246-272A-0300? -------- '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: Drainfield&manifold orientation&layout,Septiolpump 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. .art MAR t4AQr - - 3 t .Rcord Drawing Attached LIVVIt 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 a# 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 n alto ed Record Drawing is accurate, form and attached Record Drawing is accurate. Si natu of Instal r Dpte 4/JL Printed Name of&jnee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public He h: Signs of n i an—mental flea Specialist Date (stamp, signature and date) THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 81211201$ RECORD DRAWING (continued) t4 3M fl ' / ivy } ° ' nn SON COUNiY FNVIROP�ti4ENTA�NEA���