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HomeMy WebLinkAboutSWG2020-00478 - SWG As-Built - 1/8/2026 • RECORD DRAWING (ASBUILT) pg. 1 M��®N G4VN°�Y PUBLIC HEALTH PARCEL IDENTIFICATIQN Permit Number SWG 2620 --()01-11F Assessor Parcel# 32.0 21 510 2C()9 Applicant Name joN S e c()i10vLC 0)11 Subdivision (Name/Div/Block/Lot) Applicant Address.0',V\(),� '.n \VIA any\ City, State, Zip 20 5 ,S'6 e_l./GC:1-�. 2_(.4 Installer Name �� ,S V !(��``�— (`Q si-YU cho 1 Site Address SVa\--(\'\c VOA �t - ' '�( Designer Name `�"I l '��U1/11--Er INSTALLATION CHECKLIST ❑ Full System Installation Tanks)Only ❑ Drainfield Only ❑Repair CI Other System Type �%1 (WI ±V Pretreatment Type >5 ft.from foundation? - !\`,` '; - - -- ❑ N/A I ES .❑ NO ' - - - •�l >50 ft. from wells? - -S- ❑ �� ❑ • >50 ft. from surface water? --- - I - -- - -.1 ' - ❑ /� ❑ QI—� Cleanout between building and tan ,P - El rrrttt��i 0 to Tank baffles present? - ,j " - - -- ❑ ❑ r24"access risers over each compart . ?- - ❑ 5 ❑ III Effluent filter installed?- -� � ElI ❑ tn Sh � br Septic tank size � gal Manufacturer � t ® D-box water level and speed levelers used? - - ❑ N/A YES ❑ NO ®2 Manifold/D-box accessible from surface? ❑ ❑ mE Check valves installed? - - ❑ ❑ cl,Q n Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 1N 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 1y YES ❑ NO ® >100 ft. from wells?- - ❑ -'<-, C ❑ J >100 ft. from surface water? - - ❑ ( � ❑ IT >10 ft.from potable water lines?- - ❑ C ❑ > 5 ft. from property lines and easements?- - El OL• ❑ ii > 30 ft.from downgradient curtain/foundation drains? - - ❑ - p V c]® Drainfield level and observation ports present - - ❑ ( ''1 ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) 1 Proper cover installed over drainfield?- - ❑ Lk ❑ Pump tank setbacks consistent with septic tank? - - 'It'I. N/A ❑ YES / ❑ NO Pump tank size l")/a/ gal Manufacturer Y 1 lc,, 24"access riser(s) and accessible from surface?- - )K1 ❑ ❑ Alarm or Control Panel Installed? - - ❑ LI n Control Panel equipped with Timer/ETM/Counter- - ❑ ' ❑ // r Cl- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other I/ !QV YAM, § Pump Make/Model nI`- ElFloats I r.'7❑ Transducer r R Tank draw down V\/ f1`" in/min Pump capacity l4 ict-t gpm Squirt Height ti Vi'( ft Pump on time A (A Pump off time V //..-- Daily flow set at A/P-' gpd Updated 12/7/2015 w MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# RECORD DRAWING ❑ Drainfield&manifold orientation&layout w/dimensions for re-location. ❑ Trench/bed dimensions and critical distances within layout ❑ Septic/pump tank )--- ..--)5:. Ac"---c--Ac.- '51( placement ❑ Location of buildings existing/proposed ❑ Observation ports, clean-out locations, &manifolds/d-boxes ❑ Location of wells, surface water,roads, &waterlines. ❑ Reserve area(s) ❑ 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 al/information contained on this I further certify that all information contained on this form and ached Record Drawing is accurate. form and attached Record Drawing is accurate. 1/61/1 Stu e of Installer Date ill KtilitkUllAM„(X 0)/\Printed Name of Signee $ �`c• . tir 7F /- MASON COUNTY PUBLIC HEALTH s'' t-` tfr ti;, The undersigned approves this Installation Report and " 510x.:73 ;rte Record Drawing on behalf of Mason County Public c 1Aa!Es R.rlturrfER • Llc_Fnisrb nt sl ---- Health: - �-`� :. �c..r.t Q: I'9),YJc"1 1 `a)1 Signature of Environmental 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 Updated 1217/2015 •d • =ii, • { Z�Ev`s - a ' i J1.1 I . 30-_cam,+ �. --_. .)... I "'° 1,\ ! — - :- .- /,tom - ₹ Y t^�; s �!f'C�.�!-��L�0i1!J��tf� 3 ..� �G,-1J,1•.._±_=✓�, y�F `'.-�_z�--� t=_—.. _._... .. r . 11 _ _-5 ri -.e F :.j /171 I 1, �� * / . . . -7 . , 5-7/// /1-' .. :. . . t.'`‘ - ' . . - i ,_-_::lAPPROVED . I.! `- JAN 0 8 2026 ._ j ' MASON COUNTY ENVIRONMENTAL HEAL"' I • - RET I .1-.-: ---- z i• J�' 5101/173 .�� J=Nd H UNIT-ER. P,_ASS©C_ CON-nom,CrOR � ' IAMB. tiJfl R P_O. BOX 162 OLY,WA 98507 7] J,N.�Jy^ ICFN5ED DESIGNER ii iCi,C �T-<Z - _ 763-1226 _ =nis..aL�oa.-,..=I-2'-Zi EXP 'E5: 03/22/..G - r RECORD DRAWING Sze aoDJts LEG.e,L• •QWNER- _ r Y '`rj - FSNAL DATE