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HomeMy WebLinkAboutSWG2026-00164-ASBUILT - SWG As-Built - 6/29/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2o2,(p - Parcel # L1 ZZO 1 SO - a66 (0L Applicant Name �� � �fa�Y Subdivision (Name/Div/Block/Lot) Applicant Address q 1 City, State, Zip \y,c (\ y.A) gb5ya Installer Name n()nL ( \ eS Site Address nj Nd(. by5h V)f. Designer Name r — INSTALLATION CHECKLIST ❑ Full System Installation 'ank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pretreatment Type >5ft. fromfoundation? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A YES NO >50ft. fromwells? - - - - - - - - - - - - - - - - - - - - - ',01-1(: ❑ - water? - - - - - - - - - - _ - - vZ1i >50 ft. from surface K^ Cleanout between building and tank? - - - - - - - - - - ----_- - - ❑ .* ❑ U Tank baffles present? - - - - - - - - - - - - - -- - - - - - - - - - - - - -- ❑ ❑ F- 24"access risers over each corn pa ' - --- - - -- - - - ❑ ❑ uU Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ ❑ Septic tank capacity (working) gal Manufacturer Vfc11 (iV( 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A ❑ YES ❑ NO XO Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - .- ❑ ❑ ❑ 19z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ ❑ ❑ 0Q 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 14 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - -- Li N/A Li YES Li NO O >100ft. fromwells?- - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑ W >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑ ti >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑ Q > 5 ft. from property lines and easements?- - - - - - - - - - - - - - -- ❑ ❑ ❑ > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - -- ❑ ❑ ❑ ❑ 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) gal Manufacturer Z H24"access riser(s)and accessible from surface?- - - - - - - - - - - - - ❑ ❑ ❑ a Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - -- ❑ ❑ ❑ Control Panel equipped with Timer/ ETM /Counter- - - - - - - - - - - ❑ ❑ ❑ Pump installed in ❑ Bucket or ❑ On Block or ❑ Other iLPump Make/Model ❑ Floats or ❑ Transducer p=„ Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8121/2018 RECORD DRAWING (continued) I ► ci( ► x I o I APPROVED JUN 29 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET 30' - ( 1 105}cll '6 Flew io6o