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HomeMy WebLinkAboutSWG2026-00059 - SWG As-Built - 5/7/2026 _- Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2026-00059 Parcel# 32104-56-00033 Applicant Name Denise Curico Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 882 City, State, Zip Tracyton WA 98393 Installer Name Wes Graves Site Address 471 E. Michelle Dr. Designer Name N/A INSTALLATION CHECKLIST ❑ Full System Installation ❑■ Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pretreatment Type >5ft. fromfoundation? --------------------------- ❑ N/A ❑■ YES ONO >50ft. fromwells? ------- ----- ----------------- ❑ ❑■ ❑ >50ft.fromsurfacewater? ----------------- --- --- - ❑ ❑■ ❑ Z Cleanout between building and tank? ------------------- ❑ ❑■ ❑ Tank baffles present? ------- --- ------ -- - - -- - ---- ❑ 0 ❑ 24"access risers over each compartment?---------------- ❑ 0 ❑ tW Effluentfllterinstalled?--------------------------- ❑ 0 ❑ Septic tank capacity(working) IM-1250 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? --------------- 0■ N/A ❑YES ❑ NO 9O Manifold/D-box accessible from surface? -------- -------- ■❑ ❑ ❑ c9 Check valves installed? --- --------------- -------- ❑� ❑ ❑ GQ M Transport Line Size 4" Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10ft.fromfoundation?------ --------- ------- --- - ❑ N/A DYES ❑ NO W >100ft. fromwwells?---------------------17------- ❑ ❑ ft.-100 from su water?-------- d'I---->10ft.frompotabl� lines?---------------Z > 5 ft.from property lines an asements?--------- - ❑ ❑ ❑ >30 ft. from downgradient curtain d�ation drains?---------- ❑ ❑ Drainfield level and observation ports press t - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel use heck on Proper cover installed overdrainfield?------------- ----- ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?-- ---------- ❑ N/A ❑ YES ❑ NO `.C Pump tank capacity(flood) gal Manufacturer Q24"access riser(s)and accessible from rface?------------- ❑ ❑ O Alarm or Control Panel installed? -- ------------------ ❑ , ❑ Control Panel equipped with Tim /ETM/Counter ---------- ❑ ❑ ❑ Pump installed in ❑ /Bu t or ❑ On Block or ❑ Other 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 8212018 Mason County OSS Installation Report pg. 2 Parcel# 32104-56-00033 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- Q YES No If yes, please describe:Pumped tank and removed to set new tank in same spot Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- ❑E 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,Septic/pump tank location,North arrow,reserve drainfieid,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. Record Drawing Attached 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 I further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 03-27-202E Signature9/Installer Date $4'f M"& Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: ( YV c1-if Signature of Environmental Heath Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 iq 7r'rw rt O • Sr77 j7Yi9. • panupuoo ONIMV G 42103321