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HomeMy WebLinkAboutSWG2026-00097 - SWG As-Built - 4/30/2026 Mason County OSS Installation Report pg. I MASON COUNTY PUBLIC HEALTH APPLICANT!PERMIT INFORMATION Permit Number SWG 2O 14Q 7 Parcel # ZZO1 061514 Applicant Name L.4- cfil`., cr4,( Subdivision (Name/Div/Block/Lot) Applicant Address Ob 6 5%ij3 &) City, State, Zip S1 f (I g Installer Name Site Address ,/ ' E,%' 05 Designer Name #i� INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only [Repair ❑Other System Type iA ,72t3,,t 6' Pretreatment Type A//4 >5 ft. from foundation? - - --- - - --If --- - - --f=�rE3 f2 fl-1 /r4 ❑ N/A YES ❑ NO >50ft. fromwells? - - - - - - - - - - - --- L f-1 ® ❑ >50 ft. from surface water? - - -- - - ---- -- - f+ - ��y�_LUZU -h j ❑ HCleanout between building and tank? - L---- ---- - -'::;J . ❑ ❑ 0 Tank baffles present? - - - __ _ - - - \J4/. . ❑ ❑ 24"access risers over each compartm rff`?'- ❑ ❑ W Effluent filter installed?- - - - - - - - ---- --- - - - - ❑ ❑ Septic tank capacity(working) I dO gal Manufacturer C Xi5,7&JE 0 D-box water level and speed levelers used? - - - - - - -- - - - -- - - ❑ N/A YES ❑ NO �0 Manifold/D-box accessible from surface?- - - - -- - - - - - - - -- - - O ❑ Check valves installed? - ❑ ❑ 2 Transport Line Size `? �"�• Schedule/Class 3'�9(71 Bedrooms installed (check one) ❑ 2 N 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation?- - - - - - _ _ - _ - - _ - _ _ •. ❑ NIq YES ❑ NO >100ft. fromwells?-- - - -- - - . 4 X2`3/42 ©�`� -- ❑ ❑ >100ft. fromsurfacewater? - - - -- - - - - - _ _ ___>10ft. from potable water lines?- - - - - - - =_ (- - �' . '_ � ❑ >5 ft. from property lines and easements. - -- --- ------ - -- -- - - >30 ft.from downgradient curtain/foundatiopd )r§? f-'-- ' -'1 ®C ', ❑ Drainfield level and observation ports present - - - - - - ���Jr�iMNT ❑ f ❑ ❑ Graveless chambers or , Clean gravel used? (ch'ecic,gne) AL HEALTH Proper cover installed over drainfield?- -- - - - - - - - - - - - - - - -- ❑ ❑ Pump tank setbacks consistent with septic tank?- - ----- - - -- -- NIA ❑ YES ❑ NO Pump tank capacit ood) gal Manufacturer Z 24"access riser(s)and a' ssible from surface?- - - - - - - - --- -- ❑ ❑ ❑ Alarm or Control Panel Installed- --- ❑ ❑ Control Panel equipped with Timer/ETM nter- - - - - - -- - ❑ ❑ ❑ Pump installed in ❑ Bucket or Block or Other ti,, Pump Make/Model ❑ Floats or ❑ Transducer Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS stttgon Report pa. 2 Parcel#2ZZ )0--6 3 Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - - YES NO If yes, please describe: Were all components pumped out an properly abandoned per WAC246-272A-0300? - -- - - - -- 0 YES �® RECORD DRAWN0 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&me rfold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cl`eanouts,anc other maintendnce access po;nts. Incomplete Record Drawings may create additional delays in final installation approval and related permits. I � I CL) 5 .ham App ,{ . � _ . NVIRpNr17ENT AL HEALTT 1 Record Drawing Attached INSTALLER D2Sl3NERI e GiNEE I certify that F installed the system in accordance with ' 1 certify L, a x 1 af�,'hsysrern 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 ✓ubffc Health and that any deviations here have been Clearedlapproved by both the designer shown here have been cleared/approved by both... and Mason County Public Health and meet all State ;3 myse fd Mason County Public Health and meet all and Mason County Codes. s s Stare and Mason County Codes i further certify tha ail i•;c ,.a�;on con a,ne on in'; r r ry r •r ! o i i �� i 4ihEr F', 7t3 t:?at au information contained on this form and attach c rGcorc Dray-A'rr.q is accurate.e. 'i eij c attached Record Drawing is accurate. Signature of Installer Date_________ A- s r Printed Name of Signee �'� 'p' T MASON COUNTY.`K.'BLIC •9 .`C} -f 9t a �Q• /. 1�. The undersigned approves this installation Ne✓or7 ant? � f �ry "' Record awing or. behalf of Mason County Publico LICI Heal . '' 2. . , . ' I Sign ture 4f n fronmental Health Specialist Date i (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PiJBL-;C VIEW.ON THE MASON COUNT'WEB SITE Updated a,'2vzois qtr 190 E Stavis Rd, Shelton, WA 95584, USA, Timber Lake-Harstine Island Township, Parcel Id: 220185300144 BENCH -- -- -' _ i Foundation ' 1 100.00 -- Septic tank -- 21 99.501 o Outlet i -- — Bottom of drainfiele4 96.50 `� ------- ------------------- H Ii Parcel Lin s Buffer 5 ft ' ' 4 2 i Existing 1200 gallon sep_t_i_c tank 4 , ' � 3 �Primary drainfield — ' ti, t �`6i� 4 ;Failed existing system_i q \� ,� F' 5 j Reserve drainfield 6 Waterline -- G1S Legend +~� ---- ^-f Nleasui a Length "-� �-``-'~ t Goa• WA Mason 10 ft. Contours Scale=> 1 in _ 0