HomeMy WebLinkAboutSWG2009-00242 - SWG As-Built - 4/6/2011 RECORD DR iTN ASBUILT Mason Count blfc Health
Permit Number SWG (, )R_nl/2 q Z— Assessor's Parcel# �Z-Z3 0
(Twelve-Digit umber)
Applicant's Name 1_J(�lf� A�1� SN� Subdivision (Narrle/Divi •oi lock/Lot)
Applicant AddressQ�• Al'
Installer's Name
City,State,Zi S u s Z Desi er's Name 0. C
y
v. S ? .v
N/A yes Pi for to Completion
I. SEPTIC TANK
>5 ft. From foundation?............................................................. ❑ ❑
>50 ft from wells? ................................................................... ❑ El>50 ft surface water? ................................................................ ❑ lrr ❑
Building stubout to septic tank: cleanout if not 1-2%? ................... ❑ b
Baffles intact and clean?............................................................ ❑ Il
Dividing wall intact?................................................................. ❑ 1j
Risers installed for access?....................... ................................ ❑
El
Screen basket or fftuent filte installed?(circle one) ............-.......... ❑
Tank size:LZPO'lSgal.; Manufacture: 5?5
II. D-BOX
Leveled with water? ........................................................... ❑
Speed leveler used? ............................................................ ❑
III. DRAINFIELD
>10 ft from foundation?....................................................... ❑
> 5 ft from property lines and easement lines? ............................ ❑
> 100 ft from wells?............................................................ ❑ ®'
> 100 ft from surface water? ................................................. ❑ W,
>10 ft from potable water lines? ............................................. ❑
Laterals level to+1 inch&end caps present if not looped? .............. ❑ �*
Gravelless chambers utilized? ................................................ ❑
Gravel clean,properly sized, and proper depth?........................... 'Er ❑
PRESSURE SYSTEMS
Sand quality ASTM C-33? ..........................................�... ❑
Head height uniform >24 inches? Actual head heightQ_ ❑
Clean-outs and observation ports present?......................... ❑ Nr
Mound: Side Slope 3:1? ............................................. 0, ❑
Owner informed electrical connections must be made by
owner or licensed electrician and inspected by L&I? ............... ❑
IV. PUMP/PUMP CRAMEJER
Pump make Ny «'"A 4 C ; Pump model �Y L`(1) ❑ I�
Chamber size Z700 gal; Manufacture Se S ❑ E� C7
Height of pump off bottom of pump chamber 8 inches
Pump chamber draw-down 4T gallons per inch per minute
Pump capacity S6 gallons per minute
Pump controls: Timer Ela sed Time Meter Counter (Circle all that ❑ ❑
apply). If timer: Pump On '•IOrN+� Pump Off y vmc
Riser installed for access?......................................................... ❑ ❑
Alarm installed? ..................................................................... 0 ❑
RF
CHECKLIST
❑ Drainfield&
manifold orientation
& layout
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
placement
❑ Location of �\`��}(>
buildings
❑ Observation port&
clean-out location
❑ Location of wells&
roads
❑ Undisturbed native
soil between
trenches
❑ North arrow
CAUTION:Minor adjustments to septic tank location and drainfield orientation made in the field by the installer are J enerally acceptable
to both the department and the designer, but could in certain cases compromise the viability of the system. It is the inslaller's responsibility
to obtain prior written approval from either the health department or the designer before making any deviations from the design that affect
the system viability. Any deviations from the approved design must be shown above.
20
„�3
Installer: Check a box from Row"A"and `B", sign and date the certification
A. ❑ I certify that I installed the system without any ❑ I certify that all deviations from the design stamped
deviation from the design stamped"APPROVED"by "APPROVED"by MCPH are shown above.
MCPH
B. ❑ I certify that I contacted the designer and left the Cl I did not contact the designer prior to final cover because the
system open for inspection up to 48 firs prior to cover. designer waived the notification requirement.
I further certify that all information contained on this form is accurate. I understand that if the ' a on contained erein is not
accurate,there will be just cause for immediate suspension of my installer certification.
_ 3-ILI- Il
ignature of Installer Date
The undersigned approves this installation on behalf of Mason County Public Health.
Environmental Health Specialist Date
Revised January 2008
OH WM
HOOD CANAL
>s
i
ENCASE WATER LINE OR
SEWER LINE WITHIN i
10'OF EACH OTHER
1500 GAL SEPTIC TANK / EXISTING DRIVEIPARKING
2700 GAL PUMP TANK
i
i
8'OFF PROPERTY LINE WATER LINES(APROX)
12'x 57'SAND-LINED BED \
C -
4"TRANSPORT LINE FROM RESERV� DRAINFIELD AREA C __ _ _ r _
GARAGE TANK TO PUMP TANK I
6OFF PROPERTY LINE C
1200 GAL SEPTIC TANK
�p6
N !
AS-BUILT:
FOR: NORDSTROM JOB#:
PARCEL#: 32233-50-00017 DATE: 19 MAROH 2O11
BY: TJS DESIGN PAGE OF
NORTH ARROW: SCALE: 1" =40'
C TAHJA-SYRETT DESIGNS O 0 00'