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Home My WebLink AboutSWG2023-00160 - SWG As-Built - 3/21/2025 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SVYG Ze23-oo1[o Assessor Parcel# q=Z I-SZ-00017 Applicant Name V' -..-+- "»• Subdivision (Name/Div/Block/Lot) Applicant Address I('l SE 11 97 340, W A R8 NA, City, state, zip Installer Name (,A Ch FX Site Address 25710 M NW] In/ Designer Name 'R sx/f INSTALLATION CHECKLIST ❑ Full System Installation UTank(s)Only ❑ Oralnfield Only ❑Repair ❑Other System Type w k - Pretreatment Type V -6✓ >5 ft.from foundation? ----------------- -- -------- NIA ONES ❑ NO >50ft.from wells? ---- - -- ------- -- --- -- -- ----- - ❑ El Z >50ft.from surface water? ------ --- - - -- ---- - - ----- ❑ Rr ❑ ZCleanout between building and tank? ----------------- - ❑ fa ❑ EF p Tank baffles present? ----- - ----------- -- ---- ---- ❑ ElF- 24"access risers over each compartment?-- -------- ------ ❑ ❑ EL W Effluent filter installed?------- ---- ---- -- --------- ❑ ❑ N Septic tank size }ynb <3PA at Manufacturer 0 D-box water level and speed levelers used? ------ - ------- - ❑ NIA ❑YES RNO OJ LL MenifoldlD-box accessible from sudece?---------------- - ❑ ❑ rQ= Check valves installed? ------------------- ------ - ❑ El Of Transport Line Size Schedule/Class Bedrooms installed(check one)JRI❑ 2 ❑3 ❑4 ❑5 ❑6 ❑GommerciallOther >10 ft.from foundation?------------------------- - rom wen -- ❑ NIA ❑ YES ❑ NO >100 ft.fs? ---- ----------------------- ❑ 93 ❑ ❑ w >100 ft.from surface water? ---- ---- -------- ------- ❑ El lY >10ft.from potable water lines?------- ------- -------- ❑ ❑ ❑ ZZ >5ft.from property lines and Easements?--- --- --------- - ❑ ❑ ❑ K >30ft.from downgradient curtaiNfounda6on drains?--- --- - --- ❑ ❑ ❑ Dminfield level and observation ports present - - - ----- ------ ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over dminfield?----------------- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?------------- NIA ❑ YES ❑ NO Y Pump tank size gal Manufacturer Z 24"access riser(s)and accessible from surface7------------ - ❑ ❑ ❑ H y Alarm or Control Panel lnstalletl? ----- --- — ❑ ❑ 7 Control Panel equipped with Timer/ETM/Counter-- --------- ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Pump MakefModel ❑ Floats or ❑Transducer IL Tank draw down inimin Pump capacity pre Squirt Height ft IL Tank flow set al gpd Pump on time Pump off time Y uoexw vnaete MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# RECORD DRAWING rodimenslomand ld&maNfoid loo&layout sions for lon. bed om andistancesyout ❑ Septio/Wr p lank plawmenl ❑ Locetionofbulldings exlslinyproposed ❑ Oba.fian Pona, clean-OOI locations, &manifolds1d4,..as ❑ LOcalim of wells, surface water,road., &va terllnes. ❑ Reserve areas) ❑ North Anow If the designer or installer feel the need for additional luftmatian/comments,It may be attached, Record drawing may also be on a separate page attached. No.Pages Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER I certify that I installed the system in accordance with 1 cerf(that the system has been installed in accor- the aspic 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 have have been cleared/approved by both the designer shown here have been cleared/anproved by both end Mason County Public Health and meet all Stale myself and Mason County Public Health and meet all and Mason Coun Codas. State and Mason County Codes I further certify t all Information contained on this form and sit ed Drawing is accurate. I further certify that all Information contained on this form and attached Record Drawing Is accurate. et oflnstallar Printed Name o/Slgnee /WQ 3/sf/z� MASON COUNTY PUBLIC HEALTH The undersigned approves this installation Report and ^•? � 3 y t Record Drawing on behalf of Mason Count Public a +r^bea ^,�, Health: il7N}RN}.9W}fllid..:, ire vim- yv� Signature of Environmental Health Spedallsf Data (designer's stamp, signature and date) THIS FORM MAYBE SCANNED MID AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uw.tm tmrems ti CATCH DRAIN FOR ASPHALT I-BED HOME 66.22' n F Z x p 3 h = Z < I z I 0 2 DEC 20' 00 3 66.77 WATER METER WATER RBM IS GROUND ELEVATION ATWATER METER. RBMEL=10 APPROVE STUBOUT/CLEANOUT EL :9.5 D 500 GALLON TRASH TANK H20-RATED WATERPROOF COATED BNR 500-TANK H2O-RATED WATERPROOF COATED 'ASONCOUN AR 2 1 2015 EXISTING SEPTIC TANK WAS PUMPED AND REMOVED THE PROPOSED RESERVE AREA IS SIZED FOR 240 GPD.THE HOME IS A I BDRM. REr NMENTA(HEq(TH THE NEW WATER LINE SHALL BE DOUBLE SLEEVED AND GROUTED WITH BENTONITE. G . M1sx =>a�N . •... ......tHsn4 o-wtuNL..... sl ; RECORD DRAWING ALPHA SEPTIC SOLUTION, LLC. PO BOX 14631 TUMWATER WA 96511-4531 3604856-7242 CUSTOMER: VIRGINIA RINGSETH TPN. 42201-52-00017 PROJECTNUMBER: SITE ADDRESS: 25710 N HWY 101, HOODSPORT LEGAL: r