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HomeMy WebLinkAboutSWG2010-00241 - SWG As-Built - 1/27/2021 411 6/Z020 Mail-Jim Hunter&Associates-Outlook RECORD DRAWING (A88VI ,T) pg. 'I MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG T(}I(� (f rj;��I f Assessor Parcel#53010 3 ( 0 o p/n Applicant Name P2j(;S-ej, I - j Ckj2 .Uj Subdivision(Name/Div/BiocldLot) Applicant Address ; ZHO w• ClCu-x g6 City,State,Zip In p l-fin 1 ctJ Q 135��� Installer NameG(�j Site Address Designer Name INSTALLATI0N CHECKLIST Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type rASSvre- Pretreatment7ype }�O >5ft-from foundation? --------------------------- ❑N1A s ❑NO >50 ft.from wells? ------------------------------ ❑ ❑ >50 ft.from surface water? ------------------- ----- ❑ ❑❑ Cleanout between building and tank? ------------------- ❑ U Tank baffles present?--------------------------- ❑ Ell ❑ c24"access risers over each compartment?---------------- ❑ (_( ❑ 0] Effluent filter installed?--------------------------- ❑ Lbl ❑ Septic tank size l l-1—S; gal Manufacturer 0 D-box water level and speed levelers used? --------------- {�N1A ❑Yes ❑ NO ®O Manifold/D-box accessible from surface?----------------- Ek IRE Check valves installed?---- ---------------------- [� ❑ ❑ ❑d Transport Line Size Schedule/Class Bedrooms Installed(check one) ❑2 126 ❑4 ❑5 ❑6 ❑Commercial/OtFter >10ft.from foundation?----------------------- --- ❑ NIA Wyss ❑ NO Q >100 ft.from wells?----------------------------- ❑ d/ ❑ W >100ft.from surface water?------------------------ ❑ L�✓1/ ❑ >10fl-from potable water lines?---- ------------------- ❑ LvJ/ c� >5 ft,from property lines and easements?---------------- El ❑ �� i ® >30 ft.from downgradlent curtainifoundation drains?---------- ❑ ❑ Dr nfieId level and observation ports present -------------- Ell El [EGraveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ ❑ ❑ Pump tank setbacks consistant with septic tank?------------- ❑ N1A [�YEs ❑ No `.� Pump tank size Ii 17 5- gal Manufacturer 4 24'access risers)and accessible from surface?------------- ❑ o[� ❑ F- Oi. Alarm or Control Panel Installed? ------------ ------ --• ❑ ❑ aControl Panel equipped with Timer/ETM 1 Counter----------- ❑ ( ❑ Pump installed In ❑ Bucket or Cg/On Block or ❑ Other eL Pump Make/Model -t 0 Floats or ❑Transducer 2i It :3 Tank draw down, - in/ruin Pump capacity L::�Q gpm Squirt Height Lp 0 ft 4 Pump on time Pump off time E kfrrS Daily flow set at pd UPdste�1?lT730T5 ; ' fl ' I if d i i•;?, a o. o + l https;//tiu l lnr .dataTmhil(0linbo /idtAQQ f Aw�N0MDABL�g2 tl t4[].� Iy v NfA iM[AKABf61�4l;rRi RUgI s 6rAycw 3D/o srf lgQ(f••f l g/18/2020, Mail-Jim Hunter&Associates-Outlook i MCPH RECORD DRAWING (ASBUILT)pg. 2 Assessor Parcel# RECORD DRAWING ❑ Draintield&manifold orientation&layoul wrdimensions for re-locatlon. ❑ Trench/bed dimensions and critical distances within layout ❑ Septicipump tank placement ❑ Location of buildings t existing/proposed ❑ Observation ports, ctean-out locations, &manifoldsid-boxes ❑ Location of wells, surface water,roads, &watedines. I� ❑ Reserve area(s) t ❑ North Arrow If the designer or installer feel the need for additional information/comments,it may be attached. Record drawing may also be on a separate page attached. No.Pages Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER I certify that i installed the system in accordance wfth 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 Masan 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 certo that all information contained on this I further certify that all information contained on this fo a c d ecorri Drawing is accurate. form and attached Record Drawing Is accurate. g."z.- signawre of installer Date A;rnted Namne of lg eee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: S z� Signature of Env/ronme tal Health Speciallst Date (designer's stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updalcd 17l712015 jC � 3 #{t� E• '�$ �tl� "'� -�'°xr d,�''a `" pp� � G' !�� y�E FA f ,;, ' 9 i:' o � {htt //ryufook,livecdrrfmaiinoxCdlAQQkADAwfTYMDABI� M(ttQtOt?FjltllyQwiVi+ d�: g AItM AKAB'AATfi2Ltfrtih �l e bs96r rcvitalo3D/o ©lssl ... 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