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HomeMy WebLinkAboutSWG2025-00103 - SWG As-Built - 12/19/2025• Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH Permit Number SWG 2025-00103 Parcel# 12105-31-04020 Applicant Name Jeff Hughes Subdivision (Name/Div/Block/Lot) Applicant Address P i O ">VX ?J City, State, Zip E1.6(pekiI e t4J LUP9 Installer Name Final Vision, Inc Site Address 4901 E Grapeview Loop Rd Designer Name Acme Design, Inc .. © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Standard Pressure Pretreatment Type >5 ft. from foundation? - - ❑ N/A ®YES ❑ NO >50 ft. from wells? - - ❑ In ❑ >50 ft. from surface water? - ❑ i ❑ Cleanout between building and tank? - - ❑ ® ❑ Tank baffles present? - - ❑ ® ❑ 24" access risers over each compartment?- - ❑ I ❑ Effluent filter installed?- - ❑ ❑ MI Septic tank size 1250 gal Manufacturer Hagerman D-box water level and speed levelers used? - - 1 N/A ❑YES ❑ NO Manifold/D-box accessible from surface?- - ❑ ® ❑ Check valves installed? - - MI ❑ ❑ Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO >100 ft. from wells?- - ❑ ® ❑ >100 ft. from surface water? - - ❑ ® ❑ >10 ft. from potable water lines?- - ❑ III ❑ > 5 ft. from property lines and easements?- - ❑ MI ❑ > 30 ft. from downgradient curtain/foundation drains? - - ❑ MI ❑ Drainfield level and observation ports present - - ❑ ® ❑ © Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistant with septic tank?- - ❑ N/A ® YES ❑ NO Pump tank size 1250 gal Manufacturer Hagerman 24"access riser(s) and accessible from surface?- ❑ • ❑ Alarm or Control Panel Installed? - - ❑ I ❑ Control Panel equipped with Timer/ ETM/Counter- - ❑ IN ❑ Pump installed in No Bucket or ❑ On Block or ❑ Other _= Pump Make/Model L i‘,,LC act(` ® Floats or ❑ Transducer -- Tank draw down 1.5" in/min Pump capacity 39 gpm Squirt Height 6+ ft Pump on time 0:01:09 Pump off time 3:00:00 Daily flow set at 359.8 qpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 12105-31-04020 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑■ NO RECOR WING t ? .. r � ; This Is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development 15rpical Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. El/Record Drawing Attached CERTI FICATIOWO F1NSTAWA.IO INSTALLER DESIGNER/ENGINEER 1 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 and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 111— �I 10/27/202E Signature of Installer Date JASON SCHAUER Printed Name of Signee ma MASON COUNTY PUBLIC HEALTH = •! The undersigned approves this Installation Report andr Record Drawing on behalf of Mason County Public ucll DESIGNER Health: LEFT EXPIRES 12I15i \�'� ,�, ` 4 I✓(V t P-`- 24, Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/212018 A D 0 E Z D D K Z � � Dr- m; -z o c c 330.00' m 0 ° o m m 0- 041-\• ccn z m Cnzi F zN,_ m < 013 Z ° Z-1 m e > cn m ---1 O W C Di 07 m y cn cn m 73 7J 0 0 Z Z Z rn .1'��1 0 G D U O - m .Aiiplin �1� mcZZ0 =r ` ZI'': 400 0°P O D Q Q a �mi ' 71 z rn O A.. /.it _I zD m . / 1 ZnZV0 IM Dr X O Z op o 35r � m� J,K z 73 v T E, WI 00 - -< (I) m O • = m GG) z C r 73 3> 4 zm n D m C 4c< 0 , 2 D m O C ©ys m co O 0 .' o mi = z r 3-BR HOUSE C `. m ij 0(4 m rn= m, Q � APiliaa- o m o �rn o m / sitz_._ r i 1' 0000 ari_n_ o u u u IIr UUj0 m ,` O v.1 N 0 1 tl D m 0 A m 0 0 m to ,$ / C N A A O Z m a , IP / K n v � 00 Q o r.': 71 D (n r_ N m Z D ci .71 m N .,..:::.:. / CD D 0 ' '•\ DD g n m - m m Dm1 m > _ 41. 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