HomeMy WebLinkAboutSWG2026-00226-ASBUILT - SWG As-Built - 8/21/2026 Mason'County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG207r,, - OQZ7L Parcel# 22o(t-50 - aol-lO
Applicant Name Chai(Zyn She r,fYr Subdivision (Name/Div/Block/Lot)
Applicant Address 555 FYeefyU lid• 406
City, State, Zip Ci'mfu1 %'nt, UQ. q 7 50Z Installer Name 51Ah C MQ1 P.S
Site Address 30t C LOW2,Snoy'e UY. W Designer Name Yll CA-
INSTALLATION CHECKLIST
❑ Full System Installation Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Oyrxj Pretreatment Type
>5 ft.from foundation? - - ----- -- -_ _ _�\. . ❑NIAArYES ❑ No
'Soft from wells? - - - - -- - - - - ---------------- J' 'i �
- �' Q"bt ' "❑
Z >50 ft. from surface water? - - - - 1111 LI - '_ ?I'Yil 8 ❑
FQ- Cleanout between building and tank? _ -b ZQ2'_ _ ❑ ❑
C.1 Tank baffles present? - - - - - - 7u _ _ _ ❑ 4r ❑
1 24"access risers over each compartmen\? - - ❑ ❑
W Effluent filter installed? - - - - 1gy - -- ❑ ❑
N '
Septic lank capacity(working) l( 0() gal Manufacturer eY tnur, Pie-I-rAJ'F
O D-box water level and speed levelers used? ❑ NIA ❑ YES ❑ NO
a
� ❑ ❑ ❑O Manifold/D-box accessible from surface?-
r9 Check valvesinstalled? - - - - - - - - - - - - ❑ ❑ ❑
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?- - - - - - - - - - - - - - - - - - - - - - - - -- ❑ NIA DYES ❑ NO
>100 ft.from wells?- - - - - - - - - - - - --- ---- - --- -- - - - - ❑ ❑ ❑
W >100 ft. from surface water? - - - - - - - ---- ---- ------ -- - ❑ 0 ❑
1 >10ft.from potable waterlines?- -- -- - - - - - -- --- - - -- -- - ❑ ❑ ❑
az > 5 ft.from property lines and easements?-- - - ❑ ❑ ❑
>30 ft.from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ❑ 0
Drainfield level and observation ports present - - - - - -- - - -- - - ❑ 0 ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed overdrainfield?- - - - - - - - - - - - - - --- -- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank? ❑ NIA ❑ YES ❑ No
Pump tank capacity(flood) gal Manufacturer
Q24"access riser(s)and accessible from surface?------ ---- - -- ❑ ❑ ❑
I— Alarm or Control Panel Installed? - - - - - ------------- - - ❑ ❑ ❑
a
Control Panel equipped with Timer f ETM/Counter ❑ ❑ ❑
- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
ILPump Make/Model ❑ Floats or ❑ Transducer
y Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
update erzrrza,e
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - -- - ---- -- - ---- J
If yes, please describe'. U YES ❑ NO
Were all components pumped out and properly abandoned per WAC24S-272A-0300? - -- - -- -- - YES ❑ NO
RECORD DRAWING
This is a permanent record and muss be accurate and descriptive en u h r0 re-locate
Drawings o 9 e In whe need odr naintAmid anceg and
and future development, Typical gams,
wings contain DreinfgW&manifold orlenbtion&layout Septic/pump lank(oration.North snow re rve ereinfel0,existing and proposed WIItlInBa.l0calion of wells,waledines,
wells oOurvaJon purls rleanpuls and Other mainlenanceaccess points. Incomplete Accord Drawings may veale additional delays in final installation ap
proval and mlalra pemina.
.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 /further certify that al/information contained on this
form and attached Record Drawing is accurate, form and attached Record Drawing is accurate.
7)512117
Signature of Installer Date
Printed NFO'gnawm
f Stgnee
NTY PUBLIC HEALTH
ed approves this Installation Report and
g on behalf of Mason County Public
�7v.v tm� m 8lzc(
mnmental Health S ecialist Date
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated enlcme
RECORD DRAWING continued
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