HomeMy WebLinkAboutSWG2024-00481 - SWG As-Built - 9/16/2025 1-_ pC ['W E '
Mason County ass installation Report pg. MASON CO B�Li(1�( �qt� ,9,
APPLICANT! PERMIT INFORMATION
Permit Number SING 2UZy- 0� 8 Parcel# izsy
bZU11 --7 0009 Z
Applicant Name lAenf\t l-\ 'For c) Subdivision (NameiDiv/Block>Lot)
Applicant Address ►1 ,,s(no rc, Ry6
City. State. Zip „A\-c.1r)elASPI q gS 8y Installer Name IA(A){ j.\- YS
Site Address I.EU lr,) Lucy Ln. Designer Name 14dam }�o- fr
- INSTALLATION CHECKLIST
0 ru:i Ss: --. Insa a: 0 TanKis1 Orly 0 Dranfeid Onty (O=ceca- ❑Omer
System Type C -t Pretreatment Type
>5 ft.from foundation? - - ❑ N'A YES El NO
>50 ft.from wells? -
•
Q - i-r
❑ ❑
>50 ft.from surface water? _ �=� ! _ ❑ ❑
Z
H Cleanout between building and tank? - - - - SEP 1-�-2(}25- 0 0
U Tank baffles present? • 0
❑
d 24"access risers over each compartment By - 0 0
ill Effluent filter installed?- __ =r..1.
❑
r ❑(I)
Septic tank capacity(working) \1 ga Manufacturer MI) Pcec \-
�o D-box water level ar;: speed levelers .;sec? - - ❑ NA 0 YES ❑ NO
X0
Manifold/D-box accessible from surface?- - 0 0 ❑
OQ Check valves installed? - ❑ ❑ ❑
a Transport Line Size I Schedute/Cle_s A
Bedrooms installed(check one) ❑ 2 0 3 0 ❑ 5 ❑o ❑commercial O--er
>10 ft.from foundation?- ❑ N;A YES ❑ NO
0 >100 ft.from wells?- 0 0
W >100 ft.from surface water? - - ❑ ❑
Z >10 ft.from potable water lines?. - 0 0
Q >5 ft.from property lines and easements?- - ❑ 0
cc > 30 ft.from downgradient curtain/foundation drains? - - 0 ❑
Drainfield level and observation ports present - - 0 0
0 Craveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 1- 3 ❑
Pump tank setbacks consistent with septic tank?- , N;A YES ❑ NO
Pumptank capacity(flood) `Z `
( gal Manufacturer pe�fw�
z ��g 0 IDQ 24'ac riSer(S}and accessible from surface,-
G.
Alarm or Control Panel Installed? - • 0 0
2 Control Panel equipped with Timer 'EMI Counter- - 0 i ❑
n- Pump installed in 0 Bucket orn Block or 0 Other
c" Pump Make/Model \,V�(4 9_ct Floats or 0 Transducer
Tank draw down Le1 l i prn Sduirt Height
Pump on time �ump off time Daily flow set at gpc
U2,crsc errr !s
Mason County OSS Installation Report pg. 2 _� e
ABANDONMENT RECORD
Were existing sep.,c components abandoned as part of tuts project? -- • 71L_I YES ❑ NO
If yes, please describe __—• _ __ ___ _—_____----Were all components pumped out and property abandoned per WAC246-272A-C::.: - - ❑ YES ❑ NO
,
RECORD DRAWNG
-'.S:S a Perma-en:re:c•v.are•rust t:a atc,;rate and eescr.ct..4 s,c..gh to re.tpcate in the need et maintenance activ:..s and future development TypicaM Re:4rd
aennge comet Ora eve&mantas onertsPonek tea.Septcfpunip tank beacon.North arrow stone ttairaiato_extM.+g and Dec o:sad buadnys-location of we .waterents
,. s.obseva:,or+ Orts.aeanous a-0 other manisnawee access printp lacemphe a Rears o'awngs may ovate ad&-crusi*Offs st 5fse rstaaston as'›-wit and rotated parr
❑ Record Drawing Attached
•
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER,' ENGINEER
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 I further certify that all information contained on this
form a1 attached Record Drawing is accurate. form and attached Record Dre g is accurate.
_14r,444,1___ 9/r/21
S.a ture tr;...a Date x, •44.e ;��� etl iu�t s'
Printed Name of Signe= moo. °�� + c
MASON COUNTY PUBLIC HEALTH ke 4 '•1.c>\
The undersigned approves this Installation Report and 5700ttz %
ADAM J.HUNTER ..
Record Drawing on behalf of Mason County Public -L'ir -1'ti ISM _`' >
He h: , ei +: 1-1
,-.,-,' ' ' C6171 q t(6(Lc—
Sigr=•tore =iviranmental Health Sc .;ist [ sramo. signature and date
'HIS FORM MAY BE S:,ANNED AND A',A.-.A.E_E FOR PUBLIC VWEI:GN T MASON.CANTY V.EB SITE ;�xaa i''s
000 0000 —741 r---.m.. t •
Q p r- mm m mm co
). Z O z N c z m
Sr O 0 G o mo
I
O N to ? om a= C ,
ygv
O
u-1 co m
fq El
v A� g D
D m 1- m p F
a -i 271 s m O
Ma D O 5 N W N
-1 7C Z I* �' NI
M
Z O m
I- v n 2
0) n P �, ' C
mo
S
0 in
$ r
Z
6vo'* 0
0 0
m
n
U)
0
o T / 4
*4 G
rn - T 0 C
_J0 0 / \40 zi 6
` o 0
c.n O
MTA
cn = a M n
A
m = a m
m
A
.
S
O p
e
Z
1.
V
8 w
E
R
w
-15
,p 1%
0r .✓•�\1`t
I?a .f �yD • ,ss`l
m* n
• . i6.ti,-
▪ 0 0 z A • -->,1•I.
o m y D —I 0 (p -D a to I k �` ���+��
N
XXI Z IV lTI 571
���
nmN., 0 O CD na i esv o 0 CZ
on T m =
* � Z m
v z m
o coCA � --1
3 c O "�7-
0
r
m
o —I
m
to T N Z n N" 0
CO
m• D '^ -I ZD ? "<
• r >
o O r
zO O (/)m tit —I
mo N v D
r
c r
• r M
N D
r r
Z