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HomeMy WebLinkAboutSWG2024-00353 - SWG As-Built - 4/6/2026 RECORD DRAWING (ASBUILT) pg. I MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG 20 y-0o36 T3 Assessor Parcel# Applicant Name jJ h, c1,/c/ Subdivision (Name/Div/BlocklLot) Applicant Address Q'J j/ j,'...Jc C1' i)R City, State,Zip �� m ti Installer Name CI( p lj+ Site Address Io i )r L-' Designer Name jp), INSTALLATION CHECKLIST' Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pretreatment Type >5 ft.from foundation? - ____________________-- ❑NIA ®YES NO >50ft.fromwells? - ___________________ _ ❑ © ❑ >50ft.fromsurfacewater? --------_-_-_ -------- ❑ ® ❑ Cleanout between building and tank? - ------___ - ❑ ® ❑ U Tank baffles present? -_______________ ___ ❑ 24"access risers over each comrtm, n?�" ! � _ _ ❑ ©- ❑ LI.t Effluent filter installed?-_ \ \._ ❑ Septic tank size_4 q n f �: � 61Ulanufacture utA m4ii— D-box water level and spec=ielers us 0C1���y1N� ____ -d ?EN`r1R N/A ❑YES ❑ NO O Manifold/D-box accessible frar - OLL ---- ------------ 2- ❑ ❑ NIr, Check valves installed? -_______ __ ___________._ ❑ ❑ ❑ [aQ Transport Line Size )" Schedule/Class_ SGh /-/o Bedrooms installed(check one) ❑2 R 3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft.from foundation?-------------------------.- ❑ NIA ❑YES ❑ N0 >100ft.fromwells?----------------------------- ❑ ® ❑ >100ft.fromsurfacewater?----------------------- ❑ ®. ❑ L >10 ft.from potable water lines?---------------------_ ❑ ®- ❑ >5 ft.from property lines and easements?--------------- . ❑ W ❑ >30 ft.from downgradient curtain/foundation drains?- ---------- Drainfield level and observation ports present---------_____ ❑ EJ ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?------------------ _ ® ❑ ❑ Pump tank setbacks consistent with septic tank?------ ----_- ❑ NfA YES ❑ NO Z Pump tank size_______________gal Manufacturer S •.1 o /= Q 24"access riser(s)and accessible from surface?- ❑ II ❑ Alarm or Control Panel Installed? --------------------- ❑ I - ❑ Control Panel equipped with Timer/ETM/Counter----------- 0 ❑ Pump installed in ❑ Bucket or ❑ On Block or Other_ Eb 1y— Pump Make/Model D)Y�ie,; piQ ❑Floats or �Transducer Tank draw down in/min Pump capacity ?4//s4gpm Squirt Height_ / 4' ft Pump on time js..- 1-' . Pump off time P G/ iQyr. Daily flow set at 27 ' gpd Updated 12)7/2015 • MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# RECORD DRAWING ❑ Drainfield&manifold orientation&layout wldimensions for re-location. [�] Trench/bed dimensions and critical distances within layout ❑ Septic/pump lank placement , ❑ Location of buildings existing/proposed ❑ Observation ports, nx� clean-out locations, &manifolds/d•boxesti b ❑ Location of wells, t2 surface water,roads, . &waterlines. % I,. ❑ Reserve area(s) ❑ North Arrow Cam`\EPSON�iQ���� fi 5 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 th t all information contained on this I further certify that all information contained on this form and attar bd Record Drawing is accurate, form and attached Record Drawing is accurate. 2`6- Siga1re of Installer Date Printed Name of Signee '3/3/f /3//z, MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and `� Q31t3deaa Record Drawing on behalf of Mason County Public >t$rIN�W≥I€(l•„___ Heal(I)"`iicF�atl�►�. GNr (44 Li/ o Sig fur ironmentel 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 12/7/2015 368.72' 276.21' o 75'COMMON LINE Q WELL R100 SEPTIC TANKS--r 0) W R50' l z � w GLENDON C) v WELL RESERVE AREA v a �--- -------� 271 I / 0 50' I I ' 361.48' © STUBOUT WELL 20 1200-GAL SEPTIC TANK ® 1200-GAL PUMP CHAMBER \ j W VALVE BOX WITH VALVE PER POD _U THE ROAD CROSSING WAS DOUBLE SLEEVED AND Z INSTALLED PER CODE R50' 5 4 100' 0 -� DRAINFIELD INSTALLED WHERE DESIGNED. PRESSURE TEST SQUIRT HEIGHT=NA CROSSING UNDER PUMP CHAMBER DRAW DOWN=PER GLENDON RESERVE I ROADWAY TIMER SET PER GLENDON L--------------------J GLENDON I DOSEVOLUME=PERGLENDON 0 30' RECORD DRAWING 1 j•Z��2� ALPHA SEPTIC SOLUTION, LLC. 2 O �`� . .. PO BOX 14531 TUMWATER WA 98511-4531 360-956-7242 ,�P� CUSTOMER: WELL 3 �� hi PETER FIELD :b� zzoao83a TP#: PROJECT NUMBER: Z JUSTIN 5 RUSSEII /O LICENSE n orsic. " 220095100008 2008102756 /O SITE ADDRESS: 'U 120E SCENIC VIEW RD LEGAL: R50' ' PERMIT#: DATE INSTALLED: INSPECTED: R100' 4 / NOTE:THE PROPERTY OWNER IS RESPONSIBLE FOR KEEPING 2024-00353 9/25 9/14/25 I THE FLOW OF SEWAGE AT OR BELOW THE OPERATIONG CAPACITY INSTALLER: OF 270 GPD AND SEWAGE QUALITY CK CONSTRUCTION