HomeMy WebLinkAboutSWG2025-00329 - SWG As-Built - 11/14/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2025-00329 Parcel# 32127-50-00119
Applicant Name Abner Guzman Subdivision (Name/Div/Block/Lot)
Applicant Address P.O. Box 699 Lake Limerick Div. 1 Lot 119
City, State, Zip Shelton WA 98584 Installer Name T.J. Goos
Site Address 581 E.Aycliffe Dr. Designer Name Dale L.Tahja
INSTALLATION CHECKLIST
P1 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pressure Trenches Pretreatment Type
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>5 ft.from foundation? - - ❑ N/A in YES 0 NO
>50 ft.from wells? - - ❑ MI ❑
Z >50 ft.from surface water? - - El In El
tQ Cleanout between building and tank? - - ❑ 1. ❑
O Tank baffles present? - - ❑ II ❑
d24"access risers over each compartment?- - El 0 El
• W Effluent filter installed?- •- ❑ MI ❑
to
Septic tank capacity(working) 1,230 . gal Manufacturer (coated) Hagerman
0 D-box water level and speed levelers used? - - IIIN/A ❑ YES ❑ NO
ou.O Manifold/D-box accessible from surface?- - ❑ el ❑
Ca Check valves installed? - - ❑ III ❑
2 Transport Line Size \ Schedule/Class -- ."\1,,;�
Bedrooms installed (check one) ❑� 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A MI YES ❑ NO
O >100 ft.from wells?- - ❑ ® 0
W >100 ft.from surface water? - - ❑ II
Li >10 ft.from potable water lines?- - ❑ I 0
2 >5 ft.from property lines and easements?- - ❑ IN ❑
> 30 ft.from downgradient curtain/foundation drains?- - ❑ I 0
0 Drainfield level and observation ports present - - ❑ II ❑
• Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES 0 NO
• Pump tank capacity(flood) 1,000 gal Manufacturer (coated)Hagerman _
< 24"access riser(s)and accessible from surface?- - ❑ ® 0
4. Alarm or Control Panel Installed? • - 0 IN ❑
2 Control Panel equipped with Timer/ETM/Counter- - ❑ Ill ❑
m
cL Pump installed in ❑ Bucket or a On Block or ❑ Other
d• Pump Make/Model Liberty 280 e Floats or ❑ Transducer
a Tank draw down 1.75 in/min Pump capacity 44 gpm Squirt Height 8 ft
Pump on time 2.5 min. Pump off time 5 hrs. 57.5 min. Daily flow set at 180 gpd
Updated 8/21,2018
Mason County OSS,lns6lladon Ripon pg.2 Pwcei i<
Were exiling Nat components abandoned se part of tie project? . - a YES I no
It Yes, ptame dessIbec
Were all campostrrte pumped out and properly abandoned per Q YES Q ao
mive
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Mad*mak Otairdsid4 ardadd adaiUaen s bp.at 8.pannfpkean tank loaaoan.Naito awing Nam diablak ale*and mead Malaga Winn an nil&waluMaa,
well dudgeon Pelts,door sad alley roblemmen'CONS polo:, incueilias Raved Oka*O►Will aaeaM added*dal sb ad batdtden 4paj aad MAW pamdf a,
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I Record Drawing Attached
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[kBTALLER
DESIGNER/ENGINEER
I certify that I installed the system In accordance with I certify that the system haft been Installed in accor-
d*who dear acted'APPROVED-byMeson ' " vita Of spiatib d IWI stamped*APPROVED"by
County Public Health and that any deviations shown Meson County Pubic Health and that
deviations
here have been dsarddlgpprt�yied by both the designer shown hero have been +Y
d by both
end Mason County Public Her end meet ail State myself end Mown County Public Health and meat at and Mason County Codes. Stile and Meson County Codes
, I}lathercattily that all btlonnation contained on fhar 1*ober cal*that ad informefion containedon Nils
form and stteehed Drawl* - ,., i., fonn and i ,Recent'nt ,, ,. is aoounds_
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Printed Ever,"°of3 nee -! Nik
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MASON COUNTY PUBLIC HEALTH • ,,' •. , g tt
The undersigned approves this Insta�fof font and =
Record thawing on behalf of Meson(wanly public ,f Y le51 L.T I14 rr,
4� Oak L.Tat* 1
Hearth' - LICENSED DESIGNER t
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Sdpnetttrs oftits Spec/War Dere (stamp,eignature and date)
THIS FORM POISE SCANMED AMC AVAILABLE FOR PUBLIC view on THE U 4SON COMM'me sae upduao MONO
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