HomeMy WebLinkAboutUpdated As-built - SWG As-Built - 11/9/1995 AS-BUILT FORM - PAGE ONE Ravi 12/14/11
PARCEL IDENTIFICATION
II Applicant's Name &A" /41, VAIW 00,teA/ !
II �t+kZv li
II Number SWG9 - Subdivision
Permit Nu III
f� ame lvision oc
II D= Name / � .1. ,5 /�°1�CCSl4//` ZemeO3umber I
N Assessor's Parcel No. >' 3
II Designer's Name fl_s
II INSTALLER CHECKLIST I
II N/A Yes Prior to
II I. SEPTIC TANK Completion II
II A) >5 ft from foundation? II
B) Bldg stubout to septic tank: cleanout if not
C) Baffles intact and clean?
N D) Dividing wall intact? _
I1. D-BOX Leveled with water and/or speed leveler (circle) ? II
III. DRAINFIELD
A) >10 ft from foundation and >5 ft from property lines? II
B) Laterals level to tl inch & end caps present if not looped? II
C) System dimensions the same as shown on the design?
D) Gravel clean, properly sized, and proper depth? _ II
E) PRESSURE SYSTEM II
1) Sand quality ASTM C-33?
2) Head height uniform and :24 inches?
3) Cleanouts and observation ports present? II
II 4) Mound: Side slope 3:1? —
5) Owner informed electrical connections must be made by II
II owner or licensed electrician and inspected by DLI? II
IV. POTABLE WATER LINES
A) >10ft from drainfield? II
B) Wells >100ft from drainfield? II
V. pUMp/PUMP CHAMBER
A) Designed pump used, or specs attached for equivalent pump? II
B) Screen basket or effluent filter (circle one) installed? _
C) Riser installed for access? II
D) Alarm installed?
q CERTIFICATION OF INSTALLA=ON I
" • • check box from Row •B," sign and date the certification.
N Installer: Check box from Row A4 II
II ri
A. u I certify that I installed the system U I certify that all deviations from
without any deviation from the design the design stamped -APPROVED- by MCDHS are (I
stamped "APPROVED" by MCDHS. shown on the reverse side of this form.
II ri u II
II B. tJ I certify that I contacted the I did not contact the designer prior
h designer and left the system open for to final cover because the designer
II inspection up to 48 hrs prior to cover. waived the notification requirement. II
HI further certify that all information contained on this form is accurate. I understand II
b that if the informatiog. contained:hereia^ is not accurate; there will-be just_cauge:'for- -
u immediate suspension of installer certification.
u T uv 6rnMm
stgnature o n
II The undersigned approves is insta ti of half of Mason o ty Department of Health
II rv3.cQes.
e e or a e I
AS-BUILT FORM - PAGE TWO Aeviaed 12/14/94
II PARCEL IDENTIFICATION
�I Applicant's Name '� wr ANTDO �J II
�I Subdivision Rives-h'I(
II Permit Number SWG9 - / ame .vision oc o
IIc� - �j�.� Assessor's Parcel No. fZ32o- /o- o3 Zoo
Installe r's Name ZTwe ve- .ga u er
II Designers Name �L �s /��✓-� S—T i
II AS-BIIILT DRAWING
I II
ct_�yW
� II
II II
II II
II II
II II
II II
II II
II II
II II
II II
II II
II II
II • II
II II
II II
II II
it 11
II II
II II
II II
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II II
p -
cA=Cu: .Bonn adieatmeota to eepete tad: location and dradnfield orientation made In the field by the lnatatlar ase generally aC-
eepeable Co both the department and the dearer, but could In Certain caeca oaaps+omi ae the viability of the ayvtea. It is the
from eitber the bealth department or the devigner before making any
deviation•+ responsibility to obtain prior vaviabIttm lily.SMZO +l dead avat be ahoan
Above-AS-BUILT CHECKLIST II
I
Drainfield orientation u observation port location between bed. soil
na
II
II and layout ElCleanout location �rth arrow II
L: /Trench dimensions and n II
critical distances within I_J Manifold placement r
II U layout Scale of drawing shown II
Orifice placement on scale bar GAL II
U D-Box/"T"/"L" location r1 �� S
U Lateral placement, with Additional Mound information II
Septic t pump chamber distances to edge of bed u Endslope width II
Aoca .on -
u Location of _nr4 , roads r1 II
Overall fill dimensions
Location of buildings
Df�DDETAIL IN MYOPiNIONrnC l7,VANDOPEN
-- DRNN FIfID 15 WORKING
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-- I DELFlllp,WA 98�28
GOVrr 6" GOVCP dire ARr NO WrLLS
WlrfflN 100',
PCGOMI7rN0PrPLAGING pARGEL#IZ3ZO'IO'O3ZOO
Z"
1 Wlrff 1000 qd,5rPr1G
IP/Pr5 1� �PIPCS�-� TW 8GLCAN OLT OP
I RCPLAGr� 32 O-BOX,
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_ GWNCR 57ArCD PIAr fir NAD PCCN rUPNIN6
AROUND ON PAPr OF71fC DPNN PXI-0 fir l5
COlNG7ORCMOV-TtICGOVEPFROfi ONLY Z
rfir TOP OF7 r DRNN FILD BPUr I21,OF
BOTTOM OP BCD 5011C 5ANDY 50/1-5.liC l5 001NO rO BLOGK
t8 OFF APE 50 rff tr rffMf WILL BC NO Vrrlr-IZS
ON I7 AGNN NOr TO SGAL)f
RrSTR,G7Nr LAYCR
2 CAP 6A,FA6� 1
-�' WITYf LOFT
DAD �
I
DPAIE WIV
N
y 21
IZ'L.fi ( rxf5rlNG
II&7 qd 5.7. 4"P1PC � O
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A
-� D-ecx�y CXlSTING � D-BOX
M/fi DPNNFOLD � 501E LOG rmf5 V�
AFFROx1PlArr / 87CNCOVCRCD
UP BY 7fiC
SLOPC i SLOPC Dr5/6NCR.
0 60"
BROWN P1Nr SANDY LOAM)
Wlrfi L0r5 OP R0075.
l�s �
SITE INSPECTION CHECKLIST No. 6/
Check every acceptable feature. Leave every questionable or unacceptable
feature blank. Explain every blank in the space for the remarks.
ITEM APPLICABLE REGULATIONS
1. Soil in holes-describe layers fi depth Art. VI Sec 3.5(a) VII 3.3, 3.7,
10.2
2. Existing sewage systems
3. Existing structures - check use Art. VI Sec 3.5 VII 4. 1, 4.2
4. Existing wells - check construction Art. VI Sec 2. 1(b) VII 4. 1
5. Presesnce of fill Art. VI Sec 1.8 VII 3.6
6. Has soil been removed? Art. VI Sec 2. 1(c) VII 4. 1
2.4, 3.5(f)
7. Salt water Art. VI Sec 2. 1(c)
8. Lake Art. VI Sec 2.1(c)
9. River Art. VI Sec 2. 1(c)
10. Creek Art. VI Sec 2. 1(c)
11. Stream Art. VI Sec 2. 1(c)
12. Pond Art. VI Sec 2. 1(c)
13. Swamp Art. VI Sec 2. 1(c)
14. Misc surface water Art. VI Sec 2. 1(c)
_15. Property Art. VI Sec 3.5(f) VII 4. 1
_16. Banks or cuts Art. VI Sec 3.5 VII 4. 1, 3.7
17. Distance to public sewer Art. VI Sec 3.5(g),
9.2, 10.2,
10. 3 6 10.4
18. Water table - Record depth Art. VI Sec 3.5(d) VII 1.4
19. Slopes Art. VI Sec 3.5(e) VII 3.7, 4. 1
20. Driveways and roads VII 4.2
21. Drainage patterns Art. VI Sec 3.5(e) VII 4. 1
22. Interceptor drains VII 3.8
23. Culverts
24. Water lines VII 2.6, 4. 1
25. Flood control zones VII 4.4
26. Roof drains VII 3.2
27. Vegetation VII 3.2
REMARKS
BY /W DATES