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HomeMy WebLinkAboutSWG2026-00278 - SWG As-Built - 10/2/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH /APPLICANT/PERMIT INFORMATION Permit Number SWG zc?4'— 0027$ Parcel #3Z03Z - 1/2 — Applicant Name ✓t pYv..//r,d1i Subdivision (Name/Div/Block/Lot) Applicant Address 49/1) S£ (:61C Qci7+wY� City, State, Zip S/b' 4�71 WA `V-v/ Installer Name 4 Site Address Sit S£ CO/C ef) Designer Name INSTALLATION CHECKLIST ❑ Full System Installation 'Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type �U Pretreatment Type >5 ft. from foundation? -- - - - -- - --- - ---- - --- ---- --- ❑ILA EVES ❑ No >50 ft. from wells? - -- ❑ ❑ Z >50 ft. from surface water? - - -- - 1} 1 ❑ ❑ Cleanout between building and tank? H - - - --- ❑ ❑ Tank baffles present? - - -- - -- --- - �� -� ?�-���- -.r ❑ ❑ W24"access risers over each compartment J--- -- ---- --- --- ❑ ❑ Effluent filter installed?- --- - -- - Septic tank capacity(working) )ZI3 `--aaT -Manufadurer 0 D-box water level and speed levelers used? -- - ---- - --- -- - - 'N/A DYES O N p0 Manifold/D-box accessible from surface?- ---- - -- ❑ ❑ I0z Check valves installed? - --- - - - -- - ---- - - - ❑ ❑ cc it 2 Transport Line Size 7 Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - - - - -- - --- -- - ❑ MA 'YES O N >100ft.fromwells?-- - -- - - - - - - - - -- - -- -- ❑ I1 ❑ W >100 ft. from surface water? - -- -- - - ❑ Sr�]r ❑ M >10fL from potable water lines?- - - -- - ---- - ---- --- ---- ❑ R ❑ QZ > 5ft.from property lines and easements?---- - --- - --- - -- - ❑ ❑ > 30 ft.from downgradient curtain/foundation drains? - ---- - - -- - O ❑ Drainfield level and observation ports present -- - -- - W' ❑ ❑ Graveless chambers or Clean gravel used? (check one) Proper cover installed over drainfield?- -- - - - - - - --- - --- - -- O IS 0 Pump tank setbacks consistent with septic tank?- -- -- - --- ---- ❑ MA ❑ YES ❑ NO Pump tank capacity(flood) /000 gal Manufacturer /"c - (Nr Q24"access riser(s)and accessible from surface?--- ---- ------ ❑ ❑ ~ Alarm or Control Panel Installed? --- -- ------ ---- --- -- - ❑ ❑ a Control Panel equipped with Timer/ETM/Counter- - --- - --- - - ❑ ❑ Pump installed in ❑ Bucket or ,On Block or ❑ Other_ 0. Pump Make/Model OE tCt-d N - /sZ Wrlosts or 0 Transducer Tank draw down 4 in/min Pump capacity t2 ,7f gpm Squirt Height -.2 r ft Pump on time t' / 2fl1')S Pump off time ENAS Daily flow set at 2 D gpd Mason County OSS Installation Report pg. 2 Parcel# 3Za32 412-• X'/ ABANDONMENT RECORD Were exisiing septic compeaents abanccoonec s Dart at ;nis roleczT - --- - - - - -- -- -- Jtj YES ❑ NO l;yes. please descrlee: �1J'�L=�1 �.�' C s1�1va Were al ccrnperens Fcmped ou[ang properly abangcnee per WAC24&-2?2A-L3D6? ' -- --- -' KYES ❑ NO RECORD DRAWING This is a carman.,,rewm and must s xc mu and axetlptiv enough to r".in the need of mainanara acovibes and Mum dtvaopm.nt. rya:cal RewrC avlugs c]nen. oraimccW a ma,;Ixd onenm;onalayout.sapacpump taro.Ioranon.North arrow.reserve&donee:&eusrrgaredpm{wae.buildings.bOaa,of weie waadnlnaa. wxlt msenratcn sells.GN outl.arc deter rna,nter. nca access pa.3. Incomplete RecoM.^.mn'I.Na me GNR adciocna ae'a)s In Anal inawlation eppmvei and Meted rrermfts. Record Drawing Attached CERTIFICATION OF INSTALLATION -- INSTALLER DESIGNER!ENGINEER I certify that I installed the system in accordance with cartily!haffhe 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 designsr shown here have been c;eared/approved by both.- and Mason County Public Health and meet all State myself and Mason County Public Health and meet all i and Mason County Codes. I State end Mason County Codes I further certify that all information contained on this i further certify that all information contained on this form rid attach Recce o Dra'w.:g is acs rate. 'icon and a@ached Record Drawing is accurate. 9/29/26 , S a/lnsf Dote -- A _ S Printed Name o. ignee MASON COUNTY PUBLIC HEALTH The undersigned app^wes this nstaflaticn Report and { Record Drawing on benafof Mason County Public (� Health: Signature of Environmental Health Specialist,l_•11 Date (stamp,signature and date) THIS FORIA MAY BE SCANNEDAND AVAIuiS'..E FOR PUaL{;',VIEW ON THE UASON COUNTY Was SITE upmran a:zrzhis flfl ... ■ ■■■■■■■■■■. su NONE .ail i.■■■ ■■■■■■■�r aims • ■.. ..■■e��i ■. ■.. ■■.i ■.■s■s ■■i■■■■ m•m ���� iii mii IN ■■■ ■■ ■■. /M■.i. ■i ■■■ ■ ■■■ � ■..■■■■ .■. ■ ....��.....ii ■•�� iii�z■•■■.■. ■E%■■ _ ■■■■ ■%■■■ t%a flSiunit I/■■■■ ■ 4f .�■Wf■ ■ 'h► �ii)C»/■■ ■■. ►r►� `% ■■■■■■■■■■■■ ■■■ twsawsra ■■■■■■■■. om'y, r ' . . - • t in i. ► _:: ■ ■ii.■i■■.. Si fl I 11■■.■■■■MEMO iii t_%I■. _ iii •• ■__■ �■ NO ■.L1■US S.. EN ME .■■■■■■.■■■ Si,