The URL can be used to link to this page

Home My WebLink AboutSWG2025-00451 - SWG As-Built - 4/30/2026 Mason County OSS Installation Report pg. 1 MAS ON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 211Z �-- (AJ f Parcel# 2Z ! Z 5b 0/7 Applicant Name �.�r; Q id^,fr Subdivision(Name/Div/BlockjLot) Applicant Address / )4)r/J� City, State,Zip j, . 9 '"f 2 Installer Name ã Site Address 1411 N ,v'oç1, ,I V/LL.. Designer Name Ny,v&- INSTALLATION CHECKLIST- P>5 System Installation TKTank(s)Only ❑Drainfield Only Repair ❑Other SystemType_ #l-vtTy Pretreatment Type romfoundation? -_________________________- ❑Nrn fromwells? --------__-- - ❑ myge ❑ No from surface water? _ -----_ 2 f z � ❑ ❑ Q Cleanout between building and tank? - ❑ ❑ V Tank baffles present? ----------_ ❑ ❑ d24"access risers over each compartmen __--2- _____ ❑ W Effluent filter installed?-- ❑ Septic tank size _gal anufacturer l_ oo a f3 ilc' D-box water level and speed levelers used? --------------- ❑ WA ❑YES ❑ NO 0�0 ManifoldlD-box accessible from surface?-- ___ ❑ ❑ QZ Check valves installed? ---_______ - ❑ ❑ ❑ Transport L ne Size Schedule/Class Bedrooms installed(check one) ❑2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft fromfoundation?-------------------------- ❑ NrA ❑YEs ❑ NO >100ftfromwells?- _------------------------- ❑ jj >100 ft from surtace water?- ❑ ❑ Z >10 ft.from potable water lines?- --- ____ a "' ❑ >5 ft from property lines andF se ______ ___ _ ❑ ,� >30 ft from downgradi n/foundation drains?--, 1_ 202Drainfield levobservatiports present ------MA- - 2L-.•ENI R N. ENTAL HEA i r ❑ ❑ G veless chambers:or ❑ Clean gravel used? (check one) 'J Rid Proper cover installed over drainfield?-__________________ O ® ❑ Pump tank setbacks consistent with septic tank?- ----------- ❑ Nra ❑ YES ❑ NO ZPump tank size gal Manufacturer Q24"access risers)and accessible from surface?-----___ __ ❑ Alarm or Control Panel Installed? -- wax- Pump _ ❑ ❑ ❑ Control Panel equipped with T install Bucket or ❑ On Block or ❑ Other CL Pump Make/Model ❑ Floats or ❑Transducer Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on tune Pump off time Daily flow set at_ pd umcedemrzwe fL// A) Norr,H HL1-l— .: Mason County OSS Installation Report pg. 2 Parcel# ZZ I Z' G %( C?11 ABANDONMENT RECORD Were existing septic components abandoned asart of this project? --------------- YES ❑ No If yes,please descnbe: P�Sr�e' c1 (1j Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- NO RECORD DRAWING This Is a permonent record and must be accurate and descriptive enough to tedocate In the need of maintenance activities and future development Typical Record Drawings contain:Drab leld&manifold oziattation&layout,Septic wup tank location,North anow reserve draintleid,existing and proposed buildings,loran of wells,waterlines. wells,observation pods.elemrouts,and other maintenance access points. Incwnplele Record Drawings may caeate additional delays in final instafafion approval and related pemais. y iT�i 3 0 2026 MASON COUNTY ENVIRONMENTAL HEALTH jaw Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI 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 As certify that all information contained on this I further certify that all information contained on this lb an a ed Record Drawing is accurate. form and attached Record Drawing is accurate. /Z-- 9z5 Si oflnstalier Date _i I V 'L Ste' Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public H /t : LWkcAJJ V a� Sig4atUte kivimnmental Health Specialist Date (slang signature and date) THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE a1216 /'/I N /Jo�2TH I i IL L z2- )2- 50 l b o ►-7 RECORD DRAWING (continued)