HomeMy WebLinkAboutSWG2021-00225 - SWG As-Built - 10/16/2023 RECORD DRAWING (ASBUILT) pg. 1 `i MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG202 / - 602 sor Parcel it no/4/ 2cer, % I
Applicant Name -may Art VG Subdivision (Name/Div/Block/Lot)
Applicant Address 7.535T SE 7S-4*"cc_
City, State, Zip Strfoc/- i$/,n,Io./ Installer Name [ A ccM Sif'oe%bi-?
Site Address ii)7S E.. Pt Acrws/a Designer Name >>i fk-hfer
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type/5 5cz-.,-• Pretreatment Type WV-WcaM✓'
>5 ft.from foundation? - •- ❑ N/A `i YES ❑ NO
>50 ft. from wells? - ❑ Q ❑
Z >50 ft. from surface water? - - ❑ Q ❑
F Cleanout between building and tank? ❑ Q ❑
U Tank baffles present? - - ❑ 0 ❑
It 24"access risers over each compartment? \{�[,> ❑ El ❑
W Effluent filter installed?- "r ❑ CO ❑
CO
Septic tank size % 600 gal Manufacturer Soon./ Pk.CMCOJ—
O D-box water level and speed levelers used? - - I 'N/A ElYES ❑ NO
OO Manifold/D-box accessible from surface?- tit" ❑ ❑
mZ Check valves installed? - 12 ❑ ❑
0<
t Transport Line Size / .. Schedule/Class 4ik <TO
Bedrooms installed (check one) ❑ 2 ❑3 R4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- ❑ N/A RYES ❑ NO
O >100 ft.from wells?- - El Et
W >100 ft.from surface water? - ❑ ❑
LT >10 ft. from potable water lines?- ❑ EI ❑
Z >5 ft.from property lines and easements?- - ❑ SI ❑
a
K >30 ft. from downgradient curtain/foundation drains? - - ❑ ❑
Drainfield level and observation ports present - - ❑ Et ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- ❑ E ❑
Pump tank setbacks consistent with septic tank? - El �>N/A YES ❑ NO
`1 Pump tank size /20C" gal Manufacturer scr,ng) Piw->na)-
Q24"access riser(s)and accessible from surface?- ❑ E ❑
~
a Alarm or Control Panel Installed? - ❑ 0 ❑
2 Control Panel equipped with Timer/ ETM/Counter- - ❑ 0 ❑
7
0- Pump installed in ❑ Bucket or ROn Block or ❑ Other
a Pump Make/Model 7/e/Icr /V ®'Floats or LI Transducer
2
7
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time 6'C✓ Q Sr.:ar Pump off time Daily flow set at qpd
upda&d 12va015
• MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel#
,,J, RECORD DRAWING
LT Drainfield&manifold
orientation&layout
wldimensions for
re-location.
this Trench/bed
dimensions and
critical distances
within layout
Septic/pump lank
placement /C A ``
ly{ Location of buildings Ayr
�existing/proposed �`�
Observation pods, J
clean-out locations.
,y�,[[ &manifoldsld-boxes
Lf Location of wells.
surface water.roads.
&waterlines.
Reserve area(s) t- lh'
` .,North Arrow
If the designer or installer feel the need for additional informationlcomments,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 all 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.
S
�+NI-. to
Signature of Installer ate
cwais 5M in+ t `r, - z s-z 3
Printed Name of Signee
� t
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public ;r'
Health a 7. « t
ro((6fz3
Signature of Environ rental Health Specialist Date (designer's stamp, signature and date)
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 12n12a15
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