HomeMy WebLinkAboutSWG As-Built - 8/29/2025 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG
"OLD PERMIT" Assessor Parcel # 321275300203
Applicant Name JEFF LOVELY Subdivision (Name/Div/Block/Lot)
Applicant Address 16634 SARGENT RD SW LAKE LIMERICK #4 LOT 203-204
City, State, Zip
ROCHESTER, WA 98579 Installer Name BAYVIEW CONSTRUCTION (1994)
Site Address 380 E OLDE LYME RD Designer Name ADAM HUNTER
INSTALLATION CHECKLIST
❑✓ Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair
PRESSURE BED
System Type Pretreatment Type SAND UNDER
>5 ft. from foundation? - - ✓❑ N/A ❑ YES ❑ NO
>50 ft. from wells? - - ❑ 0 ❑
Z >50 ft. from surface water? - - ❑ 0 ❑
• Cleanout between building and tank? - - 0 ❑ ❑
U Tank baffles present? ❑ 0 ❑
I— 24" access risers over each compartment?- - ❑ 0 ❑
a ❑
III Effluent filter installed?- -LOCAL ❑ ❑
co 1200 Manufacturer
Septic tank size gal
CI D-box water level and speed levelers used? - - ❑� N/A ❑ YES ❑ NO
DO Manifold/D-box accessible from surface?
- ❑ ❑ ❑
00 Z Check valves installed? - - ❑ 0 ❑
cn< 2 Schedule/Class 200
2 Transport Line Size
Bedrooms installed (check one) ❑ 20 3 ❑4 ❑ 5 ❑6
>10 ft. from foundation?- - 0 NIA ❑ YES ❑ NO
>100 ft. from wells?- - El ❑
o ❑ 0 ❑
W >100 ft. from surface water? -
LL >10 ft. from potable water lines?- - ❑ 0 ❑
z > 5 ft. from property lines and easements?- - CI CI CI
a - ❑ CI CIcc > 30 ft. from downgradient curtain/foundation drains? -
• Drainfield level and observation ports present - - ❑ 0 ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑✓ ❑
Pump tank setbacks consistant with septic tank?- - ❑ NIA ID YES ❑ NO
Pump tank size 300 gal Manufacturer LOCAL
Q24" access riser(s) and accessible from surface?- - ❑ 0 ❑
I`
a Alarm or Control Panel Installed? - - CI CI CI
E Control Panel equipped with Timer/ETM /Counter- - ❑ ❑✓ ❑
D
(1. Pump installed in ❑ Bucket or ❑✓ On Block or ❑ Other
n'• Pump Make/Model HYDROMATIC OSP33 0 Floats or ❑ Transducer
d Tank draw down 6 in/min Pump capacity 40 gpm Squirt Height 5 ft
Pump on time 90 GAL Pump off time 6HRS Daily flow set at 360 gpm
revised 1/22/2014
i
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
Drainfield&
manifold orientation
&layout
111 Trench/bed
dimensions and
critical distances
within layout
Ej Septic/pump tank
placement
O Location of SEE ATTACHED
buildings
0 Observation ports&
clean-out locations
O Location of wells,
surface water,&
roads
• Undisturbed native
soil between
trenches
Ell North Arrow
If the designer or installer feel the need for additional information/comments. it may be attached.
1
Record drawing may also be on a seperate page attached. No. Pages Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
I certify that I installed the system in accordance with 1 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
a . •'.son County Codes. State and Mason County Codes
I f • er ce ify •t all information contained on this I further certify that all information contained on this
form a•• :ttache• Record Drawing is accurate. form and attached Record Drawing is accurate.
km 8/12/25
Signatu -Mgr Date
APB` UNTERvir 8/12/25
Printed N. e of Signee . <t
MASON COUNTY PUBLIC HEALTH .� ?,•
The undersigned approves this Installation Report and v}"'"`"'`. •,
;z+z.t 1. :,,:,,,
Record Drawing on behalf of Mason County Public
Health: • �wu,.x�+ER '�•
5 /I- 8/29/25 'rrrivtJtw,.w..•... •
Signature of Environmental Health Specialist Date (designer's stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
revised 1/22/2014
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