HomeMy WebLinkAboutSWG2025-00081 - SWG As-Built - 4/29/2025 (2) Wit iink
a lc
•
"n .allati n Report pg. 1 t , (�
�n County OSS p MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025 -- 06091 Parcel # 32127_ 5Z- aOO21
Applicant Name - (•auce L,c "I-1 Subdivision (Name/Div/Block/Lot)
Applicant Address 35 I e Str-ASH QoCK p iz,
City, State, Zip 56+0u 1 1 WA ctiriN Installer Name B O Seem G44-coz, c...0
. Site Address SA/v1€ Designer Name Cire4 WH'ltr
INSTALLATION CHECKLIST
%Full System Installation ❑Tank(s)Only ❑ Draintield Only ❑ Repair ❑ Other
System Type IJON CONi a24%,/1/4 f2& '2 .2-VOOLatment Type
>5 ft. from foundation? - - ❑ N/A Er YES ❑ NO
>50 ft. from wells'? - /0--Us
A ❑ ❑
• >50 ft. from surface water? - - ❑ 2 ❑
Z � �
Q Cleanout between building and tank? - - Q ❑ ,® ❑
I— l ��
✓ Tank baffles present? - Z - Ag� - ❑ ❑
d 24" access risers over each compartment? `� - - - -- 1� �� - ❑ ❑
W Effluent filter installed?- - - -_ ❑ ❑
Septic tank capacity (working) I'0#0 gal Manufacturer.I1 4.17- D6D/-
G D-box water level and speed levelers used? - - (2rNVA ❑ YES ❑ NO
DOJ Manifold/D-box accessible from surface?- -
❑ Eir ❑
Di Check valves installed? - - ❑ El 4*:!! '
°Q " i!o
2 Transport Line Size 2 Schedule/Class
Bedrooms installed (check one) vi 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- -_ ❑ N/A ElYES ❑ NO
0 >100 ft. from wells?- - ❑ M ❑
>100 ft. from surface water? - -- --
Illg ❑
LT. >10 ft. from potable water lines?- -- -- - - - -- -- - - - - -- - - - ❑ ® - ❑
Z % 5 ft. from property lines and easements?- - ❑ 24.1 El
ii > 30 ft. from downgradient curtain/foundation drains? - - Of, ❑ ❑
Draintield level and observation ports present - - ❑ X ❑
A511 Graveless chambers or ❑ Clean gravel used? (check one) •
Proper cover installed over drainfield?- - ❑ X ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A M YES ❑ NO
• Pump tank capacity (flood) 12.51 gal Manufacturer DL VW) Irt-PiN-►n'h .
Q 24" access riser(s) and accessible from surface?- - ❑ lia4 ❑
F-
a Alarm or Control Panel Installed? - - - - -- - ❑ ❑
2 Control Panel equipped with Timer/ ETM /Counter- - - - - ❑ g ❑ `ti v
d Pump installed in El Bucket or 1 "-On Block or CI Other
2 Pump Make/Model ���--�"'�- �" /✓ "` ❑ Floats or XTr ansriner
• Tank draw down 2 in/min Pump capacity_50___ gpm Squirt Height N /Z- ft
CI. -
• Pump on time • 7 /71l Pump off time 6_,-j{Q4.__-___ Daily flow seTa ` gpd
ca, 14, u ,, te,:,,;.
Mason County CSS Installation Report pg. 2 Parcel # 3212?^ OW2.
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - YES El NO
If yes, please describe -- --_----- _--.-Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES ❑ NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record
Drawings contain Drainlield 8 manifold orientation 8 layout.Sept r•p.er.o an Io<atton.North arrow reserve drrinf elu existing and propased buildings lncabon of wells.waterlines
wells,observation ports,deanouls,and other rr i:ntenance access points, Incon•piete Record Drawings may create additional delays In final installation approval awl related pormas
APpRo ,MAS°N UN ° 2025
CoUNTYENVIRpN rr
Jew MENTAL HEALTH
r
. 1
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
i certify that l 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 Piithlic 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 attache Record Drawing is accurate. form and attached Record wing is accurate.
412.9
Signature of Installer Date �-
�If1f'1, ti� "4
€
Printed Name of Signee "
y 510 t$
MASON COUNTY PUBLIC HEALTH o'c" CI, AITf
LIC SE ESIGNER
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public L``'"" `'to
Healt
Signet re it nmental Health Specialist Date (stamp, signature and date)
• THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE li511'1wd f3.212111"
. . .____.... ..
, ...
-1,
, •
'll. ..
' . 't
Jil i'
V.',
----6.....__4 ......_____j
•r....
,,, , -4: li.. ''''''
......7.6
,.. f. .6
. ............
, ,/
. .
N co ~
, ' , '
(: -...1.--------1
` iI1b3H 1�� t,
a
41�'v3�}NObUti3
ci / i
fr. a t. �ZO '�N�o)NOSV - N.
g „� Z < < 8bW
3 Q AOa • '�
5 , iOlSO S3lIdX3
c IRw Nww va►�►�.�wwVwwwwa*�! o
N
c 3;:-:, 1$30 03SN3011 '�• 6.•
•\+ e
d1. t: VN'3 ACINIO Zir [� •'
�.Q C. • �`P o r `a _.tom 600
�� ,1fe .- ,\ (wok
e I�f'i ' r �1
•
.11i
. \ ..\\. , \ \ ,
0 r4 m \\\\
Q Y Y
\ „
\ .
N � � �La YYc� • c) i
t i, I -0 Rf co c
ill to N 0 a c \
11 L 0 = 0_ E . a) ~
{ 5- C :e. D5-0c.cd1I.o,
U
fcoli
A
V 0 0 40
Xa _ PPROVE
w . QUooi > Az
N M V t fj OD fs
JUN 3 0 2025 y l
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
T t y i
2.
0 -14-- i
J•
e5":2__)
/,, , I St
.
/V (9. Ll„
. -5' 0----D
. ,6--p Ls.,
/// ,
ii,.` __i Y„.-•, ' ---f-- .f. ---E---.su ri'` -.....i trs- .{.._._Lft-_-.�_ ,, -.... i.?.
= tZ
; c--11 - V L0 4, /P ..1 ,4,d,A, �.�
Our G4/e /, -IS' £',,, c.,,e P{, L a/.Ka/
1 r' I 1v - r /sI ' I 40 6..
Ps:; .5-• Qy 1(I_ tip '1�
N
c,4. )r
CI D E.Y TEi. `�N`'��
LICE S E N
eeD __
c/eQAIa (Ai 06sx4.,iai-i
z) V oh,e gof
41) ,comte,4i v l PRO V E e
{" " 01 iry f/aly< < l
�--,� eckJ U N 3 0 2025 w :.:
/ A) Val lye l3oe04ASON COUNTY ENVIRONMENTAL HEALTH
JBW
APPROVED, '
5-:0,-/ Leyl&f 0 _ .3,,, S.. G MAR 172025
MASON COUNTY ENVIRONMENTAL HEALTr'
1`- Al P s�. , .,,,. RET414
5 '/ J Loy *.z 0 ' s'
M
e'AJa 01 LI i ./ /