HomeMy WebLinkAboutSWG2022-00396 - SWG As-Built - 1/5/2026 11/10/25, 12:33 PM Mail-Jim Hunter&Associates-Outlook
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Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
. APPLICANT/PERMIT INFORMATION
Permit Number sWG a()Da.- D 0VA(Q Parcel# 1...0` 1(}`3--S 1 1,— ( a„I
Applicant Name ("'-} dcu(' 1 Subdivision(Name/Div/Block/Lot)
Applicant Address 1,O1 t.„), „ ,W ,iL,84yv_ . i c1,1 �
City, State,Zip E ,�a„1 t.,30-. �3 cJ4( installer Name Ear\ Nmt d n
Site Address `Ot WQ ----ICn.eiL.Warie.1Z.,Designer Name d O \-10t.1\-1-€.1—
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.. INSTALLAT(0N.CHECKLIST . .
IpTull System Installation O Tank(s)Only O Drainfleld Only O Repair O Other
System Type >At/vt`p S.Qr):c. S rW\ Pretreatment Type
>5 ft.from foundation? ----- - ❑N/A Min O NO
>50 ft.from wells? - 'i-t- �.t�j_I.� -.- O O
Z >50 ft.,from surface water? - - Wit L� --. ❑ ig O
H Cleanout between building.and tar - 11 302 - -- ❑ !� O
O Tank baffles present? - - --- ❑ ❑
a24"access risers over each compE k-rtment?-- ❑ ❑
NEffluent filter installed?----- -93f 3f _ - -.- El
Septic tank size.�� gal Manufacturer P.01A Q._ tc c 4. 5
O D-box water level and speed levelers used? - - ,KN/A O YES O NO
DO Manifold/D-box accessible from surface?- - O .15. O
mz Check valves installed? - t] - O •g O
it Transport Line Size 2t/ Schedule/Class 45
Bedrooms installed(check one) O 2 ❑3 El 4 ❑5 ❑6 O Commercial/Other
>10 ft.from foundation?- - N/A ig YES O NO
C >100 ft.from wells?-
ft.from surface water?- .r
O
-1 >100 ❑
W
Z >10 ft.from potable water lines?- -__ , ,,; - . f .� O
>5 ft.from property lines and easements?•. .jr--. ----.- 1 F O
>30 ft,from downgradient curtain/foundation a cd t ENV4{.ONM®TAL HEALTH ar ❑
a Dralnfield level and observation ports present - ❑ ❑
kz Graveless chambers or O Clean gravel used? (check one` j
Proper cover installed over drainfleld?- - O liti O
Pump tank setbacks consistent with septic tank?- - O N/A `OYES O NO •
Z Pump tank size (ia06 gal Manufacturer Ht,SC trt a-5
< 24"access riser(s)and accessible from surface?. - O ) a O
,, Alarm or Control Panel Installed?- - O TEI O
2 Control Panel equipped with Timer/ETM/Counter- - O , O
P. Pump Installed in O Bucket or NO On Block or O Other
2 Pump Make/Model
r Ltb-Qc3 y P( yvv�5 c.L:�(� O Floats or ❑Transducer
R Tank draw down 1-1.5',raw"'in/min Pump capacity 13, J gpm Squirt Height r �r ft
Pump on time kg f.)01,J, 3ita( Pump off time H holitr-S Daily flow set at pd
Updated 8121/2018
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11/10/25, 12:34 PM Mail-Jim Hunter&Associates-Outlook
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Mason County OSS Installation Report pg.2 Parcel# •
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - O YES Ci No
If yes,please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - O YES O NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough tm re-locale in the need of maintenance activities and future development. llplcal Recant
Drawings contain:Dralnlleld&manifold orientation&layout,Septiclpump tank location,North arrow,reserve drainteid,existing and proposed buildings,location dwells,waterlines,
was,observation ports,cleanoula,and other maintenance access poWe.Incomplete Record Drawings may create additional delays in final Installation approval end related permits.
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311
JAN 0 5 ,1,
MASON c0-,TYENVIRo K{:
NMENT
cs telf AL HEALTH
gRecord Drawing Attached
CERTIFICATION OF.INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that 1 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
!further certify that all information contained on this I further certify that all Info .lion contained on this
form nd ttache Record Drawing is accurate. form and attached Reco Dm,in•is accurate
Signature of Ins iii Date
(I -13 -1-5.
Printed Name of Signer!, ik`�'of H
�j ° 1>,
MASON COUNTY PUBLIC HEALTH Ak„ •�c A
The undersigned approves this installation Report end ' siou273 c�t
Record Drawing on behalf of Mason County Public • t:' jAMMES R.lit ifYIER
Health: �'' LICENSED D€SIGNER
UL(47QH' f ^L" 6 EXPIRES: 03/22/2CD
Sig tu: o� vlronmental Health Specialist `Dated pL (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UPdated emnota
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CI lAPA.ES R.HUNTER
iC SEU CTE§K,P?ER
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EXl RF.S 03/22/2(0 JIM HUNTER 8t ASSDC. cote-rRAc ciR.
P,O. BOX 162 OL'C,WA 98507 5L-
753-12.26 ' xrvS LL I=A-r-E
RECORD DRAWING i SOH ADDRESS/LEGAL
OWNER - CAP--N J . . F2tvAL LcA r 11-10 Z�
TP-ir Wt 9 015100D2.1 511 C--, (D2oz _ f z,,