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Home My WebLink AboutSWG2026-00203 - SWG As-Built - 9/25/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 9o ; -- ()CY"')O ) Parcel # >\D( T - - Xx3" Applicant Name 4 C+� Q\h-(C'_,r1 Subdivision (NamelDiv/BlocklLot) Applicant Address 5D 0' STak-Vyik I City, State, Zip 4 j"Z__ Installer Name -O L-\lit\ \'ASV1 Site Address `Q S. 4 i L t Uv1WU"' Designer Name N INSTALLATION CHECKLIST 0 Full System Installation [ Tank(s)Only ❑ Drainfield Only []Repair ❑Other System Type VI Pretreatment Type N u - >5ft. fromfoundation? -- - -- - - - - - - - - - - - - - - - - - - El N/A YES [] No - - - - - - - - - - - 0 -- - - - - -- - - - - - ---- - - " � _ __ _ _ _ _ - ____ ❑ ❑ Cleanout between building and tank? - - - - - - - - - - - - - - - -- - - ❑ ❑ V Tank bales present? - - - - - - - - - - - - - - - - - - - - - - - - - - _ ❑ ❑ d24'access risers over each compartment?- - - - - - - - - - - - . ❑ ❑ LU Effluent filter installed?- -- - - - - - - - - - - - - - - - - - - ❑ . Septic tank size ( J gal Manufacturer - 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ wA YES ❑ NO - ❑ ❑ O2 Check valves installed? - - - - - - - - - - - - - - - - - - - - - - -- - - 2 Transport Line Size 7 Schedule/Class Bedrooms installed (check one) ❑ 2 :.J 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- _ - _- - - - _ -_ - - - - - ❑ N/A J,YES ❑ NO >100ft. fromwells?- -- - - - - -- -9Øi - - ❑ >100ft. fromsurfacewater? s�T > vW`_� ❑ ❑ W - - - - - - - - ❑ Z >10 ft. from potable water lines?- - - - - -- - r _ - El ❑ > 5 ft. from property lines and easements?- - - - - � J- _ ❑ ❑ Er > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - fl ❑ oraveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- - - - - - - - - - - - - - - - - ❑ ❑ Pump tank setbacks consistant with septic tank?-- - - - - -- --- - - ❑ N/A ❑ YES ❑ NO Pump tank size gal Manufacturer Z Q 24"access riser(s)and accessible from surface?- - - - - - - - - - - - - ❑ ❑ ❑ ~ d Alarm or Control Panel Installed? - - - - - - - ---I - - - - - ❑ ❑ El Control Panel equipped with Timer/ETM/Coun - - - - - - O ❑ ❑ Pump installed in ❑ Bucket or ❑ On Bloc or ❑ Other ILPump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd t�,ds%d W212018 Mason County OSS Installation Report pg. 2 ParI# 3Z l 0& "" 3 coo 3 O ABANDONMENT RECORD Were axtetIns septic cornpcnents abandoned as part of th project? ---------------- YES O No If Yes, please descrrLe: Were al components pumped out and property abandoned per WAC246.272A-0300? -------- )WYES 0 NO RECORD DRAWING Tai is i 1d a.aOi ppj�b !NMd of scavm.i r 1W RUCwd ii4rkA & j &load, k c n.NOM ,m ms®ve ski.and,, mid p ii d h d&49k btaion d+psks,WWWR s, Pats L p�,st P( Ms Rm d Dr NkW nwy aR�ele WM de p b f a d kl reoel IOw tom.pen . AllWV �J LYYT 9/3-Z 6 ❑ Record Drawing Attactred CERTIFICATION OF INSTALLATION W4STALLER DESIGNER!ENGIN R I certify that I installed the system in accordance with I coiliIy that the sy stem has been installed an aoco,- the septic design stamped APPROVED'by Mason dance with the septic design stamped"APPROVED'by County Pubiic Health and that any dew shown Mason County Public Health and that any deviations here have been cieanedleprayed by both the designer shown here have been cearecf/approwed by both and Mason County Pubic Heafth and meet a#State myself and Mason County Pubic Health and meet all and Mason County Cods. Stake and Massa County Codes I further cer£ify that all information contained on this I further certify that a#biibnnatkn contained on this forma Record Drawing is accurate. Aorm and attached Record Drawing is accurate. f Da -�rMIAJ m Pfln ted Name of Si nee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health_ Signatzte onentaI He aitth Spoast Da&e (stamp, signature and date) TFSS FOF &MAY tiE S O J�li4N,AiuE f i0R Pt JG 11ESY1r(Z4 TIE WISi0N COUNTY 1Nt8 SITE 4dwd errhmre d f v P,(.- Zto6 3g1x_( O - vø(:/2(06 - . -- .J --- -- --— -- r __ - - [ - 44 Pp - _- --� _ - - f� l) cUNrr --------------- ra ,•� ©NA q� '�tNT ___ -- ii1 r - \ ____ __ __ _ : TIff _ tJ: -TtiiT ' t± Yn �_ JV -- - -- cJrf i� � r1cGam. _- - i--- .cfthiv< yfLt 1h __ ' g&' $ .I csJs _.