HomeMy WebLinkAboutSWG2024-00351 - SWG As-Built - 4/16/2025uill
/ Mason-Cpunty OS,
Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
iv Q �' 35 Parcel # [taj JG �� /y
r. Permit Number SWG2 ��
�. Subdivision (Name/Div/Block/Lot)
Applicant Name t�
21 Applicant Address _✓� 5. 1 (0•- ' 5% 424 ( \ ,
��G WA �3 I staller Name
City, State, Zip Pi Cl yf L' c2Z
Site Address
liii-la E 4va{t4-1 1- esigner Name
INSTALLATION CHECKLIST
❑Repair ID Other_____--_
�.Full System Installation ❑Tank(s)Only ❑ Drainfield Only
.i;I
��,,`sue Pretreatment Type
System Type
I
❑ N/A DYES ❑ NO
>5 ft.from foundation? ❑ CI
>50 ft. from wells? ❑ ❑
zEl
>50 ft. from surface water? - El ❑
Cleanout between building and tank? - ❑ 0
V Tank baffles present? - 0
d24" access risers over each compartment? ❑ Eg�� 0
coW Effluent filter installed?- 0
Septic tank capacity (working) t Zt�' gal Manufacturer
✓ 1 •u 1'R ��+fit'`
0 D-box water level and speed levelers used? • - - 1N/A BYES ❑ NO
0O Manifold/D-box accessible from surface? ❑ � ❑
m- Check valves installed? ❑ L^J{ 0
en Q I,
2 Transport Line Size 2 C_ Schedule/Class 40
Bedrooms installed (check one) 121 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ N/A 2;I YES ❑ NO
C) >100 ft. from wells?- - ❑ N. ❑
W >100 ft. from surface water? - - ❑ ❑
li >10 ft. from potable water lines?- - ❑ ❑
Z > 5 ft. from property lines and easements?- - ❑ IK ❑
12 > 30 ft. from downgradient curtain/foundation drains? - - ❑ Cl
cl
Drainfield level and observation ports present - - ❑ 121 ❑
❑ Graveless chambers or t4 Clean gravel used? (check one)
Proper cover installed over drainfield?- ❑ in ❑
Pump tank setbacks consistent with septic tank? - ❑ N/A ag YES ❑ NO
Y Pump tank capacity (flood) I2-15 gal Manufacturer 195 J +'r' r '' �
z 24" access riser(s) and accessible from surface? El ❑
t—a Alarm or Control Panel Installed? - - ElEl
Control Panel equipped with Timer/ ETM/ Counter- - ❑ ❑ ,(
a Pump installed in El Bucket or tg] On Block or El Other_ \I*l
a. Pump Make/Model �"�v� J Z90 [Floats or ❑ Transducer
H D
a Tank draw down L in/min Pump capacity 44 gpm Squirt Height ft
Pump on time I MIA Pump off time 4?14 _ Daily flow set at yar) gpd
Updated 8121i2018
siii
Mason'County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
•
Were existing septic components abandoned as part of this project? - - "'C YES El NO
If yes, please describe: _
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - OYES El NO
RECORD DRAWING
This Is a permanent record and must be accurate and descriptive enough to relocate In the need of maintenance activities and future development. Typical Record
Drawings contain Drainfield 8 manifold orientation 8 layout.Septic/pump tank location,North arrow.reserve drainfield,existing and proposed buildings,location o'wells,waterlines,
wells,observation ports.cleanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
07) 4/4 // CI l.JQ e,l y
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a11 �_ i`-
pex- Cleo AA, �aClr /
64 e.),,,e_ LY;e011.1#1,4 ay,
.[Record Drawing Attached
1
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
l 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 I further certify that all information contained on this
form and attach Record Drawing is accurate. form and attached Record Drawing is accurate.
a 1 bithil
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Signature of Installer Date
i '-I 3 En n/ .•-. ` t'
Printed Name of Signee o _ n , ,��
E
"41:. k ,odd
MASON COUNTY PUBLIC HEALTH `� •,�y`� v ,�%4', V
The undersigned approves this Installation Report and / �' CID .w T E, •�t„1� l
. . MEN DESIGN' E `'�`�
Record Drawing on behalf of Mason County Public L4' ►��+..•�..w.+�• 1:<<. =.
e>'„ �r.,.EXPIRES O5,1o/.. :... :11:6
Health:
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VI Jit7-s-- 'I
Signature of Environmental Kealth Specialist Date sI nature and date)
(stamp, g
i THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Uprl.rieiI s',i,1'2°18
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7 1) .
1 . Residence
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2. Audio/visual alarm 7cl nor
3. Clean out
4. 1200 gallon septic tank 4
5. 1200 gallon pump tank 4 Q L - ' '
6. Transport line ` d
7. Valve box
8. Repair drainrfield envelope GI) Vl/
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a�eAPPROA
4a ' ' f° • ' / ' —a APR 18 2025
MASON COUNTY ENVIRONMENTAL HEALTh
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�, c . 4ieg .' klr, ocZ PROVED
Co5�1130 S APR 18 2025
IIIILESIGNER MASON COUNTY ENVIRONMENTAL HEALTH
EXPIRES u51Oi RET
ORIFICE SPACING 5
Lateral# Length Length Orifice # Distance from Distance from end Length #
# (Feet) (Inches) Spacing " Orifices feeder line of end of lateral
1 42 504 60 9 1.5 0.5 42
2 41 492 60 9 0.5 0.5 41
3 31 372 60 7 0.5 0.5 31
4 21 252 60 5 0.5 0.5 21
135 30
TRANS LENGTH 120
GPM 17.7
K (2" SCHEDULEN 40) 284.5
FRICTION LOSS 0.7044977
Squirt 2
Elevation difference 25
TDH 27.704498
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APPROVED
APR 18 2025
' '"N COUNTY ENVIRONMENTAL HEALTH
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