HomeMy WebLinkAboutSWG2022-00340 - SWG As-Built - 8/9/2022 MIITM
RECORD DRAWING (ASBUILT) pg. 1 AUG 0 3 2022 v MASON COUNTY PUBLIC HEALTH
PAR IDENTIFICATION
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Permit Number SWG Zj L Z- OU.390 Assessor Parcel # 3a 01(0- 51 -v o oa 3
Applicant Name R 4,i- Re.,( eski.e_ L CSubdivision (Name/Div/Block/Lot)
Applicant Address �G _l W«iir_ r P,�r1C �( Cxv1K1 - 13ev-c_\- Tv's a3 --. V.-
City, State, Zip S 11-\\-�;i ! l.,i!A 9(t5,1s /- Installer Name Ult,. E•cz~..w' ,,-,
Site Address 0210 G S.1-,,-v - CC+ 3 Designer Name Acd,,> ), t4,;, ;,`*p y-
INSTALLATION CHECKLIST
❑ Full System Installation Is Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type 6- 47 Pretreatment Type
>5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
>50 ft. from wells? - ❑ ❑
Z >50 ft. from surface water? - - ❑ ® ❑
HCleanout between building and tank? - - ❑ ® ❑
V Tank baffles present? - - ❑ IZ ❑
a24" access risers over each compartment?- - ❑ XI
`W Effluent filter installed?- - ❑ V4 ❑
Septic tank size 0 60 gal Manufacturer ,7,A k ,.,---
0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO
oil
O Manifold/D-box accessible from surface?- - ❑ ❑ . ❑
DQ IDCheck valves installed? - - ❑ ❑
2 Transport Line Size Schedule/Class �,•
Bedrooms installed (check one) 2 3 ❑4 ❑ 5 6 4f{Y1. IY'51C(tL 512244 �w 2 bd
>10 ft. from foundation?- / El
❑ N/A ❑ YES ❑ NO
>100 ft. from wells?- - ❑ ❑ ❑
cl
W >100 ft. from surface water? - - ❑ ❑ ❑
LT. >10 ft. from potable water lines?- - ❑ ❑ ❑
Z > 5 ft. from property lines and easements?- - ❑ 0 ❑
a2 > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ ❑
ci
Drainfield level and observation ports present - - ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑ ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES ❑ NO
Y Pump tank size gal Manufacturer
< 24"access riser(s) and accessible from surface?- - ❑ ❑ 0
~ Alarm or Control Panel Installed? - - ❑ ❑ ❑
a
2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑ ❑
n
- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
d Pump Make/Model ❑ Floats or ❑ Transducer
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpm
revised 1/22/2014
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
Drainfield&
manifold orientation
&layout
Trench/bed
dimensions and
critical distances
within layout
Septic/pump tank
placement
❑ Location of
buildings
ID Observation ports&
clean-out locations
Location of wells,
surface water,&
roads
❑ Undisturbed native
soil between
trenches
El 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 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate.
7f z�jtZ
Signature of Installer Date
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
I ?)(gfz7
Signature of Environmental Health Specialist Date (designer's stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
used 1,22/20ta
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