HomeMy WebLinkAboutSWG2021-00607 - SWG As-Built - 12/18/2024 MASON COUNTY PUBLIC 4 c 111k
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tson County ()SS InstallatioAPPL IICANTI PERMIT INFORMATION
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�Zr 7 Parcel# ,
Permit Number Subdivision (Name/Div/BIOck/1-00
Applicant Name s 4_r
Applicant Address S/ E
w�A�.yF•� r Installer Name
City, State,Zip
Lss S � C Designer Name
Site Addle
INSTALLATION CHECKLIST
Orainaeld Only ❑Repair ❑Omar
(Full System Inetalletiw ❑Tank,)only ❑ Pretreatment TyPe_�----
System Type C.aNvr
>5 ft.from foundation? --------------------------- ❑WA U' VES NO
- ❑ ❑
>50ft.from wells? - -- ---------- -----------------
❑ � ❑
Y >50 ft.from surface water? ------- --- El
HCleanout between building and teNr? --------"'--"-"-" ❑ � ❑
V Tank baffles present? ---- - --- ----"------- ❑
W2C access risers over each compartment?-------- ❑ ❑Effluent filter installed?- ---- --- - - - -I15".1 gal Manufacturer----"-- - ❑
N 3?�
Septic tank capacity(working) 05
O D-box water level and speed levelers used? - -- ------- --- - - ❑NIA pl YES ❑ NO
J ❑
C0 Manifold/D-box accessible from surface?-------- ❑
o?= Check valves installed? - "------ -- El El
c< --io3q
f Transport Line Size q Schedule/Claw
Pr—T-----
Bedrooms installed(check one) ❑2 ❑3 14 115 116 ❑COmmerciallOther
❑ NO
,to ft.from foundation?---- ------"'- --"---`- -- ❑
WA KVES® ❑
G >100 ft.from wells7- -- ------ ---'-------- ❑ ® El
>100 ft.from surface water?---------- --- -- ------- - ❑
U. >10fL from potable water lines?-------- - -'-- - - ❑ ❑
Z >5ft.from property lines and easements?- -------- --- ❑
>30 ft.from downgradient curtain/foundation drains?- - --- ----- ❑ ❑
Dreinfield level and observation ports present - --- - - -- -- - - -- ❑ ❑
❑ Graveless chambers or Qf Clean gravel used? (check one) �( ❑
Proper cover installed over drainfield?--- -- - ----- ------ -- r❑ 'r�r
Pump tank setbacks consistent with septic tank?--- -------- - - al WA ❑ Yea ❑ No
2 Pump tank rspecify(flood) gal Manufacturer
Q 24'access riser(s)and accessible from surface?-- --- - -- ----- ❑ El~ Alarm or Control Panel Installed? --- --- - - - -- - --- ---- - - ❑ ❑
6 ❑ ❑ ❑
2 Control Panel equipped with Timerl ETM/Counter--- --- - - - - -
6_ Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
6 Pump Make/Model ElFIoaM or ❑ Transducer
ILTank draw down n/min Pump apacky gpm Squirt Height fl
Pump off time Daily lbw set at 9Pd
Pump an time agweazvm+e
. I
'son County ()SS Installation RBABA Parcel# 2`It'�'1 —1) �GR
NDONMENT RECORD 0 YES
Were existing septic components abandunetl as pert of thla Dialect?
YES NO
If yes. Please describe'. WAC248-272A03007 -
Were all components pumped out and properly abandoned per
RECORD DRAWING
ims Is a p `end 1-ana and moat W¢cureN and da¢tlµrve ennugn m rNacata In ua n 01 malnunance aoynita and Whin..—WmeM. Lylllul RNCAId
pump 1a11ow,— NMeanew,retlme&.Afield ealslwg and pr,i5na Cmldrnila_b Wn 01 w¢II5 wIdii vl
11mnll-nnan IXnmfia106manilOb urenlnnnn 81aWu1.Sep4 tl
m,mx.rvalmn pone ereamns.aneamer mamlemm�.e a¢esx pares Inwmpam ROcan Orawng5 mayu le atldilrowl'mlaya In feral ins,blial approvelaM rNnled permits.
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I certify that 1 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.
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Signetureoll`nstaller Date �,
Flirted Name of Signee `\�
°n w.ssa npasai
5
MASON COUNTY PUBLIC HEALTH "' "" '"
The undersigned approves this Installation Report and Expw�'
Record Drawing on behalf of Mason County Public
Health:
Slgnalure or tnvl�ionmenral HealthSpewabst Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uVlnaa B'irxdm
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MASON BEN50N RD J
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APPROXIMATE
NEW HOME I
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PRIMARY&
RESERVE
PER DESIGN
� D-BOX �90 I
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� SEPTIC TANK
LOCATION
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50'ATTENUATION
\ ZONE
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\ SHARED WELL APPROVED
\ LOCATION
\ DEC 18 1024 I
\ MASON COUNTY ENWRONMENTA[
RET HEALTH
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R `\ xEcoxn DRAVAM
CLLSTOMER: RKIIARD MAYO
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ER DIGCON INC PARcH atiw+�oo�
SEPTIC DESIGNS ADDR6S, MERODS COIAT FM
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ll0 GKII'EVIEWWA98596 DLSIG'JEA: ROBPRTH.PA1SSE °"�` `-3WM26.11k13 FAX 3b 427-2353 SHEET: A.M&T Sc,4m Psw