HomeMy WebLinkAboutSWG2023-00060 - SWG As-Built - 7/6/2023 RECORD DRAWING(ASBUILT)pg.1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
,l '32 9 3
Permit Number SWGZ(J L3 QCLt�C Assessor Parcel p 3 0 13 3 ��
Applicant Name ( jj� Subdivision(Name/Div/Block/Lot)
Applicant Address Cl
City.State.Zip Wstaller Name g(S(, chip Cc.l�st�1n L r
Site Address 5c � Designer Name IVY)-t1.i11-k.!' A cccIC
INSTALLATION CHECKLIST
❑Fur System Installation anfk(sl Only ❑Drainfield Only ❑Repair ❑Other I
System Type (}1A Pretreatment Type /
>5 ft from foundation? - 0 N/A f-[r� cEs 0 NO
>50 ft from wells' • ❑ EF ❑
Z >50 ft from surface water' - 0 EV 0
FQ- Cleanout between building and tank?• El __,/ 0
V Tank baffles present?- --• 0 L� 0
F- 24-access risers over each compartment?- ert��----. ❑ [t� ❑
a 1 V�
rW Effluent filter installed - Jet.��-�° ❑t G11 /� 0
1i 0 9 l a dd Septic tank size 2(0 33 C cyqr n Manufacturer Cni'rt 1 1(( (1 n�Q�.'\
O D-box water level and speed levelers used?• - 0 N/A Q4es 0 NO
QOJ Manifold/D-box accessible from surface?- - 0 ❑
OQCheck valves installed?- f I • El ,I [5- 0
2 Transport Line Size I /Schedule/Class S(.kLfLt( l-1 ' k C
Bedrooms installed(check one) ❑2 3 ❑4 0 5 ❑6 ['Commercial/Other
>10 ft from foundation?- 0 WA l_ ❑YES 0 NO
G >100 ft.from wells?• 0 y 0 0
W >100 ft.from surface water?- - 0 /` 0 0
LL. >10 ft from potable water lines'- 0 i 0 0
Zir >5 ft from property lines and easements?- ❑ 0 0
d >30 ft from downgradient curtain/foundation drains?- - ❑ 0 0
o
Drainfield level and observation ports present• • 0 • ❑ 0
❑ Graveless chambers or 0 Clean gravel used? (check one) 1
Proper cover installed over drainfield? ❑ If 0 0
'54v 9 �� Pump tank setbacks consistent with septic tank?- rE5 NO
lika�i s Y Pump tank size2V33 S? gal Manufacturer
Z
a Q 24-access nser(s)and accessible from surface? ❑ 0
F- Alarm or Control Panel Installed?•
a i0 ❑
teXat
• Control Panel equipped with Timer/ETM ouster- [� 0
7
a. Pump installed to 0 Bucket or On Block or ❑ Other
CPump Make/Model &i1(LS}' IV) ���,,�j,�❑gdFloats or Transducer
R Tank draw down �y1)1/rAit1�Ob}in Pump capacity(*���>(�h dlfni quirt HerghtPrOV 1R
a + �- 11 1 0 -
Pump on timAD Sec• Pump off time Daily flow set at . •1 __
3U1 2 6 2023 U
By
MCPH RECORD DRAWING(ASBUILT)pg.2 Assessor Pace a
f RECORD DRAWING
rl 0 Dramfieia&marolou
onentaton 6 layout
w/dimensrons for
re-location
❑ Trerx0vbed
dimensions and
onbcal dalances
wdhrf layout
❑ Septicpomp ta•,.
placement
❑ Location of ouldngs
costing/proposed I,T G V
❑ Ooservayon ports e P
clean-out locations
&mamfoldsid-pores t)J'G
❑ I ocaten of wells.
surface water roads
&waterlines
❑ Reserve areals,
❑ North Arrow
lithe designer or installer feel the need for additional lnt rmatiorVcomments 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 actor•
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 Meson 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 fur )C dify ).ell Info i lion codtaineo on tM'it.
form at had Record Drawing is accurate/ 111,� pf fo aRj eWoed Reco %% 1r g is: r • .
40
Signature of Inst r Date—AA' $': •y 1.�/
Fri Name of Srgnee /Clays. '1•.1.
oQ.. A ,. 1
MASON COUNTY PUBLIC HEALTH 0,:' t .0,i,
The undersigned approves this Installation Report and w w �61
It# Record Drawing on behalf of Mason County Public i $ bane ,'AO 1/4�1'�
.�/
Health: ry. 1AIIM191.11.IHWl9101EIR ''. 1I�hl
6 6,4_i'fi I�._ . ( tGttl . lei
1��� (`\' Say 7 )z� .,..`..;... ",.�.u`�.....`.,....r
Signature of Environrrtat Health Specialist Date (dee s gTMp,*Aire and date)1.
THIS FORM MAY 8E SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE r.0arwe,Meomn
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