HomeMy WebLinkAboutSWG2024-00322 - SWG As-Built - 9/11/2025 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG (2_ ,,a - aU, Assessor Parcel # 32.02/- 57P 62- / 0
Applicant Name -'- iLL aicz �t .fi4 Subdivision (Name/Div/Block/Lot)
Applicant Address A d/i(C 12. -ei ,Stfnl + i <�',yL,,,y . ‘„,( /u ,4.i,a/
City, State, Zip OL j tttiO A, , t Lid V94 Installer Name I3rU, /W%iU' �L
Site Address .4-7- l 4 '‘YLa,- D✓.g Designer Name SA4 4 5 fcv-
-t4 -7-ei•F U1,4 ¶e,SV Y
INSTALLATION CHECKLIST
g.Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type Lew $LC, eatment Type ��/t
>5 ft. from foundation?- -
❑ N/A ,YES ❑ NO
c �11 Li
ft. from wells? -V�A ® pp
Z• >50 ft. from surface water? , P�6 ❑ R AtrO ❑
Q Cleanout between building and tank? - - 1 . ❑ ® Ihi ❑
H
U Tank baffles present? - - - - - ❑ g ❑
F— 24" access risers over each compartment? 8q - ❑ N ❑
a
I W Effluent filter installed?- - ❑ E. ❑
Septic tank size 124'V gal Manufacturer SNYZ>GZ
0 D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO
OLL
O Manifold/D-box accessible from surface?- - El El
00 Z Check valves installed? - - ❑ ® ❑
0Q
E Transport Line Size 2, �r Schedule/Class 3k&'i)u e 46
Bedrooms installed (check one) ❑ 2 -IA 3 ❑4 ❑ 5 ❑6
>10 ft. from foundation? - - [11 N/A V] YES ❑ NO
>100 ft. from wells?- - - - - ® ® evb1<<- ❑
o
- >100 ft. from surface water? - - ❑ HI
Li >10 ft. from potable water lines?- - ❑ gi (39 ❑
Z- > 5 ft. from property lines and easements?- - ❑ ® ❑
Q
Ce > 30 ft. from downgradient curtain/foundation drains? - - ❑ lil AP ❑
• Drainfield level and observation ports present - - ❑ gl trAti ❑
g Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A El YES ❑ NO
• Pump tank size 12j2 gal Manufacturer /ilL/ .0,4
< 24" access riser(s) and accessible from surface?- - ❑ [ ❑
~ Alarm or Control Panel Installed? - - ❑ R ❑
a
2 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑
D
n- Pump installed in ❑ Bucket or [ On Block or ❑ Other
2 Pump Make/Model IG�Gly aFloats or ❑ Transducer
Tank draw down ,./ in/min Pump capacity (Q V gpm Squirt Height On 0ft
EL GPil
Pump on time -7. 0 Pump off time eo •7 Daily flow set at 347C/ gpw
revised 1/22/2014
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
Drainfield&
manifold orientation
&layout i4 i1-G tt
Trench/bed
dimensions and
critical distances
within layout
Septic/pump tank
placement
Li Location of
buildings
El Observation ports&
clean-out locations
El Location of wells,
surface water, &
roads
Undisturbed native
soil between
trenches
El North Arrow
If the designer or installer feel the need for additional information/comments, it may be attached. /
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 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 1 further certify that all information contained on this
form and attac'-d Record Drawing is accurate. form and attached Record Drawing is ac rate.
• ?Si
Signature of Installer Date e •-Z,p - L.S•
�jiGll /uC!u244G r Yr
��,•o`
Printed Name of Signee -k=s,ti 01
MASON COUNTY PUBLIC HEALTH 4`4' I,> ,d;,tip
Iwrl3 s>•�
The undersigned approves this Installation Report and o,' IAMB It 41ifIfER '
Record Drawing on behalf of Mason County Public IJCENSF6[>r tC;N±`R
Health: EXRPtES: 03/22/.
I It
Signature'of Environmen'al 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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APPROVED
- _o�- _.------ -SEP 1 1 2025 .
MASON COUNTY ENVIRONMENTAL HEALTH
RET
6 -2d - 1-S'
>. JIM HUNTER. 8& ASSOC. CONTRACTOR
A ti,- d,wnJyti`4i
y• : .F' P.O. BOX 162 OLY, WA 98507
�� t: t i ti'A t31,`A... nn c..-tc..rn.js 41.-
\�{,. ` '' !f.(� 753-1226
• INSTALL DATE
y' S1!ai:73 `>
2• SITE ADDRESS/LEGAL
O !AMES R.WITH RECORD DRAWING
IICFt'sTO[)ESK,NER �►� 'P.A�.1s,tZA-ten e��.
�. - rr OWNER-��.L-L N rr tVtL, 4-y.
EXPIRES: O3I2Z1 y�.�D FINAL DATE
• SwG
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