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Home My WebLink AboutSWG2012-00029 - SWG As-Built - 4/19/2012 Feb 08 04 06:30p Joycelyn Johnson 360-898-2255 p.2 'ON-SITE SEWAGE SYSTEM RECORD DRAWING Mason County Public Health Permit Number: SW13 ,2O? l - O Ova 9 Assessor Parcel#: 3a 3 30-S 06 El 7 Applicant Name: ti i a yAL L j?_ Mr GRgW Subdivision(Name/Div/Block/Lot): _T Address` 4 3 iW#LdA!4_Df P-0- A.0 ,wAui2.-rie9 of drI< 6,ua4-i3 it ilue_ Gty/State/Zip: o,U 4i A Shy ti+t/A _ 9if_S10 Installer Name: Q W ur--e_: M I c liA i Mc_r ,P_&µ/ Site Address: 193 0J- C404-L 14.de A-WA44 Designer Name: '!o i c-e i in TnA A)S,0 J COMPONENT CHECKLIST (Check ad that apply) GENERAL eFull System installation ❑ Septic Tank Installation Only El Drainfield Installation Only Tanks: 0(Septic Tank U Pump Tank ❑ Pump Basin ❑ Grease Trap reatment ❑ Sand Filter ❑ Mound ❑ Sand-Lined Drainfieid ❑ Glend loFilte ❑ ATU ecirculating Filter ❑ Other: Lgz AAe ainfield: ❑ Gravity Dist. Pr ure Dist. ❑ Sub-Surface Drip AIVERS COMMENTS givers needed for the instadation of this system?....................... [t3 YES❑NO ere waiver mitigation measures followed?.................................. OYES❑NO SEWAGE TANKS&TREATMENT COMPONENTS SETBACKS MET? WAIVER/MITIGATION 1W from public well............._...................................._...................... OYES ❑NO 50'from private well,drinking spring/surface water.................__.. WYES ❑NO 10'from wager supply lines......................................................_.. dYES ❑NO 5'from foundations,prop./easement lines,downgradient curtain/foundation drains, lad YES ❑NO tormwater component setbacks met? .... ..........__........_..... ..... DYES ❑NO NERAL I tank inlets and outlets water-tight joined water-tight to cast-in adapters?......................................... L1 YES ❑NO ❑N/A 1 tank risers joined with watertight sealant to cast-in adapters?........................ ............................... VVES ❑NO ❑N/A tank lids water and gas tight?..............................................................._.............................................. 'YES ❑NO ❑N/A inal grade in tank area sloped to divert standing water away? ........................................ g V................... ..... ES ❑NO ❑N/A ank Inlet/outiet/connector pipes ASTM3034 or better?......................................................................... EV/YES ❑NO ❑N/A ner informed electrical connections must be made by owner or licensed electrician and inspected byL&1?.............................................................................................................................._.............. � ❑NO ❑N/A sternhard-wired?........................._........................................................................_.._.......................... N YES ❑NO ❑N/A SEPTIC TANK REASE TRAP leanout between budding and tank?............. Z'YES ❑NO eanout between budding and tank?._............... ❑Y NO Tank baffles present/functional?............. affl eYES ❑NO tank nk-bes present/functional?........................ YES ❑NO Tank dividing wall present/functional?.JVA..... DYES eNO V acces`s risers over each compartment? ........ ❑YES ❑NO 4"access risers over each compartment?........ R(YES ❑NO material: ''C3 concrete ❑ erg" ❑Poly Septic tank effluent filter make/model: ❑Other •' — - ®QTank mfg: Tank material: IffConcrete ❑Fiberglass ❑Poly Size of grease trap c artment(gal): ❑Other: 1 #3 tt4 ank mfg: U C61.-e.adA- ize of septic tank compartments(gal): - 1 00 O tit #3 #4 ga. • •S'' Revised 3/15A01z Page 1 of 4 Feb 08 04 06:31p Joycelyn Johnson 360-898-2255 p.3 PF 150 l PUMP ill PUMP 03 ump tank size.........._.................. r.�flj.Af#4-.X.......................... gal Ell= gal gal ump tank manufacturer_._._._...��,1(._�,tx......�°`1\..2A..fe..:t .. um tank material concrete,fiberglass.etc. Pump tank gallons per Inch.........._........................ ..._....._..._ ........._ gal/1nch gale gal/inch Pump type(circle onel..._................ ................. rinder/solids/liquid n solids liquid rinder/soiids/liquid Pump makelmodeL...q.h��S{,a Is pump discharges to(fie^Id/filter.Etc.). . ump intake height off bottom..........................._......._........... ....... In. in. in. ump in vault that draws effluent 19-24'off tank bottom?._...._.,.. YES ❑NO YES ❑NO DYES E7 NO itches(circle one)....__........_............._......................._......._............... oats/TransducerFloats/TransducerFloats/Transducer Pumpdrawdown................................................................_.,.......I...... in/min in/min in/min Pumpcapacity.........................................................................._..... gal/min gal/min gal/min ontrol panel make/model.OAEWC.A:,M*Jc.l_LVLY�?55.f I...�0 D�f udio Visual Alarm Installed?......................:...................................... YES 0 NO YES E]NO YES ❑NO ump controls(circle all that apply)......-....-.....-...._.._.........._......... m ETM/EC imer/ET imer/ETM/EC me Dosing or Demand Dosing?(circle one)................... ................. i demand Im /demand timed/demand mp'ON'Time.........._.........._..._....._........................... .I......... _.... mp'OFF'Time._..........-......_..................._....._...._............_.._....._..... dual daily flow set to pump..._................................_........................ gpd gpd gpd TREATMENT UNIT Aerobk Treatment Unit ;le Pass Filter Type Make/model: VAM IEA2D T Int.Sand Fifter 0 Mound 0 Sand lined Drainfield Proprietary: ❑Other: Recirculation Filter Type liter media clean&free of excess fines? YES 0 NO ❑Gravel Filter (rProprietary 0 Other: Iter media used(C-33,etc.): -3 3 Filter media dean&free of excess fines? .. 0 NO edia Source(name of pit,etc.): Filter media used(pea gravel,C-331 etc : [ter media depth: Media Source(name of pit,etc.): �+ ctual squirt height: Filter media depth: ^ filtrate return flows by gravity/pressure(circle one)to: al squirt height TEXT/LE glitter method us tendon Recirculation RaFIo: odel: 0 M31 El M32 ElOther. Filtrate return flows ra /pressure to: _ umber of basins: in material(cone./fiberglass,etc.): f sealing conc.mix(KIM,etc.)use ............._.....0 YES ❑NO DISINFECTION liners used? ❑YES 0 NO .._.... ......._................... [es,'erve er media clean&free excessive fines?.......... 0 YES ❑NO Disinfection Unit dia Source(nam pit,etc.): ake/model: /�� l primary a covered w/12'sand?..................O YES O NO covered w/sand? .............[]YES [J Np[]PARTIAL Comments: Novked 3/15/2012 Page 2 of 4 TRANSPORT LINES • WAIVER/MITIGATION ETBACKS MET? 100'from public well......................................................................... YES ❑NO 50'from private well,drinking spring............................................. :` ES ❑NO YES ❑NO 1V from surface water&water supply lines................................. Y 2'from foundations ........................................................ C YES ❑NO tormwater component setbacks met?........................................... YES ❑NO Transport line size: Class/schedule: Check valves installed? YES B sect?. WO Manifolds/Splitters/D-Bo s accessible and adjusta le from D-Box water leveled&speed levelers used? ❑YES surface?............5rYES ❑NO Leveler model: DRAINFIELD&RESERVE AREA RAINFIELD SETBACKS MET? WAIVER/MITIGATION 1 100'from wells,drinking spring,surface water?........................ (J YES ❑NO 50'from downgradient cuts/banks with<5'soil above 6ES ❑'NO restrictivelayer.......................................................................... 30'from downgradient curtain/foundation drain/ditch............. 9YES ❑NO 5'from downgradient cuts/banks with W soil above restrictive BYES ❑NO layer.................. ................................................ 10'from water supply lines,decom.well, foundations............. C9'YES ❑NO 5'from property&easement lines................................................ DYES ❑NO tormwater component setbacks met?....................................... LYYES ❑NO Date of drainfield installation: L Depth of cover over drainfield: Drainfield install d in dry soil conditions?...........DYES ❑NO #Yards of cover used: L` /1 ravel used?®YES ❑NO Size: Clean?...9YES ❑NO Type cover material used(i.e.sand,loam): �a � `"`P" raveliess used? ❑YES ❑NO Make/model: Cover material source(site/pit,etc.) CERTIFICATION OF INSTALLATION r STALLER DESIGNER ertify that I installed the system in accordance with the certify that the system has been installed in accordance ptic design stamped"APPROVED"by MCPH and that any ith the septic design stamped"APPROVED"byMCPH and viations shown here have been cleared/approved by both that any deviations shown here have been cleared/approved the designer and MCPH and meet all State and Mason County y both myself and MCPH and meet all State and Mason odes. ounty codes. further certify that all information contained on this form is nd the attached Record Dfurther certify that all rawing scontained accurate.on this form Vignature of Installer to �4 MASON COUNTY PUBLIC HEALTH �. The undersigned approves this Installation Report and • w" o Record Drawing on behalf of Mason County Public Health: yac" g 51{ 28 >✓ 2 JOYCELYN Q.JOHNSON Signature of Environmental' ealth Specialist Date O i •st�I�Ef� DESIGNER Comments: 'P. (Designer's Stamp,Signature&Date) Revised 3/15/2012 Page 3 of 4 Feb 08 04 06:31p Joycelyn Johnson 360-898-2255 p.5 RECORD DRAWING (Required) CBXCKUST Drainfield& manifold orientation &layout Trench/bed dimensions and , vas c►iticaIdistances b�� ,! wlthin layout v- ��V� p 6 r- 12( Septic/pump tank G��1.� •Q - placement i o aft Lrl' location of rU ` ry Jr buildings If 8d rm d observation port& La rf,e-- clean-out location til°O f Eir location of wells& roads �� c Undisturbed native soil between trenches 169%I oQ sG M"North arrow ,�1k_� ICO go �`� D elk O`4��t�b �►�ad d ?� Revised 3/25/2012 Pape 4 of 4