HomeMy WebLinkAboutSWG2025-00347 - SWG As-Built - 6/27/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 20 3.47 Parcel # 3z. '2 j Z,4g b I(3
Applicant Name TYJ1 Subdivision (Name/Div/Block/Lot)
Applicant Address t37,n S�,Arc'�� iA '
City, State, Zip Shd4nn Installer Name -1-0,!L 44•vs or
Site Address Designer Name ? �a�1
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type `Pr," Pretreatment Type
>5ft. fromfoundation? - - - - - - - - - - - - - - - - - - - - - - - - - - - MN/A DYES NO
>50ft.fromwells? - - - - -- - -- - - - - - - - - - - - - - - - - - - -- ❑ ❑
. , Cleanout between building and tank? - -- - - --- - - - - _ _ _ to ❑ ❑
o Tank baffles present? - - - - - - - - - - - - 0 e0
P24"access risers over each compartment?- - - - - - - - - - --- -'- - ❑ ❑
W Efuentfilterinstalled?- - - - - - - - - - - By- - - - - -- ❑ ❑
Septic tank capacity(working) ?j Qn gal Manufacturer
•
0 D-box water level and speed levelers used? - - - - - - - - - - - - - -- ® N/A ❑YES ❑ NO
Manifold/D-box accessible from surface?- - - - - - - - - - - - - ---- ❑ ❑
GQCheck valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - -1 �J ❑ ❑
Transport Line Size 2 Schedule/Class St)1. 4-®
Bedrooms installed (check one) ❑ 2 ❑3 •0 4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.fromfoundation?- - - - - - - - - - - - - - - - - - - - - - - - - - �JN/A DYES ❑ NO
G, •
>100ft. fromwells?- - - - - - --- - - - - - - - -- - - - - - - - -- - - ❑ `R] ❑
W 9>100ft. fromsurfacewater? - - - - - -- - - -- - - - - - - --- - --•-
❑ ❑
>10 ft.from potable water lines?-- - - - - -- - - - -- - - -- - - -- •- ❑ ❑
aZ >5 ft.from property lines and easements?- - - - - - - - - - - - - - - - ❑ ® ❑
> 30 ft.from downgradient curtain/foundation drains? - - - - - - - - - - KI ❑ ❑
Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ to ❑
❑ Graveless chambers or Clean gravel used? (check one)
Proper cover installed over drainfield?-- - - - - - - - - - - - - - - - - - ❑ ❑
Pump tank setbacks consistent with septic tank? - - - - - - - - - - - -- ❑ N/A YES ❑ NO
Pump tank capacity(flood) I' Zo 0 gal Manufacturer s' A .��'.-f 4 .
Z
Q'. 24"access riser(s)and accessible from surface?- - -- -- -- -- - - - ❑ J ❑
0~. Alarm or Control Panel Installed? - -- - - - - - - - - - - - - - - - - -- gi ❑ ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ J ❑
Pump installed in ❑ Bucket or 0 On Block or ❑ Other
Pump Make/Model I/I . 2 ?0 JJ Floats or ❑ Transducer
a ,Tank draw down Z in/min Pump capacity 4 2 gpm Squirt Height S (," ft
Pump on time d Pump off time G l/r. Daily flow set at .3 c gpd
Updated 8/21/2018
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Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD"
Were existing septic components abandoned as part of this project? - - - - - - --- ---- -- ❑ YES NO
If yes, please describe:
Were all components pumped out and properly abandoned 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,Septic/pump 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.
Record Drawing Attached
CERTIFICATION,OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 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.
-Signature of Installer Date
____________ A
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH _ h `a
The undersigned approves this Insty��l(ttion ReP0and ��+ y y�
O Va Public 3 Drn6HT T.SIMPSON G G r Z.
Record Dr ing on behalf of Mas n ® � L
Health: ryFiyy: EXPIRES11/04, ,
7(3a 0 %
Signature of Environmental Healt Specialist Date HF��Tb (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
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