HomeMy WebLinkAboutSWG2008-00266 - SWG As-Built - 7/18/2022 (2) RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG QO8 -0 e 2-la COAssessor Parcel # 2ZI 05.0OO61-/
Applicant Name \ .V((1 Lc& *\) Subdivision (Name/Div/Block/Lot)
Applicant Address PC) f3O X 2_7 I
City, State, Zip I-I C(/C4 M r WA c(g5 50 Installer Name Bo J S1V' -. C v S+tiC l( f 1
Site Address 7Z0 r M ks6vi L 1 L DC S Designer Name --a N14-1 V tt- ASSOC.
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s) Only ❑ Drainfield Only [:1 Repair ❑ Other
System Type 2Y S c(J►7-ei Pretreatment Type
>5 ft. from foundation? - - ❑ N/AS�Y S ❑ NO
>50 ft. from wells? •
Z >50 ft. from surface water? - - t V ❑ rIt1/
HCleanout between building and t. \- - -U -�(.%-'1- - - - - - ❑ E ❑
U Tank baffles present? 11 - ❑ El/,/ ❑
F- 24" access risers over each comp. - ent?- !\ - - -- -- ❑ L� • El
CL
W Effluent filter installed?- St - ❑ fg7i ❑
N
Septic tank size I/ ( Z 6 gal Manufacturer - VeYq t-Uf\ oreat.c-T
0 D-box water level and speed levelers used? - - ❑ N/A EKES ❑ NO
XO Manifold/D-box accessible from surface?- ❑ ��,/ ❑
u.
OOZ Check valves installed? - -L n❑ D" ❑
Q `L 0
� Transport Line Size I 1�� 'I Schedule/ lass
Bedrooms installed (check one) ❑ 2 ❑ 3 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A BYES ❑ NO
a >100 ft. from wells?- - ❑ El ❑
W El' El>100 ft. from surface water? - - ❑
tL >10 ft. from potable water lines?- - ❑ EY ❑
Z > 5 ft. from property lines and easements?- - ❑ a- ❑
12 > 30 ft. from downgradient curtain/foundation drains?- - ❑ [X ❑
Drainfield level and observation port present - - ❑ ❑
❑ Graveless chambers or lean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ Eic ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A YES ❑ NO
Pump tank size 1 42-0 D gal Manufacturer C--V•tre3 f!'C-i/N e vc ac '1-`
< 24" access riser(s) and accessible from surface?- - ❑ L-r�,'� ❑
F- - - ❑ ,E,/ ❑
a Alarm or Control Panel Installed? ❑ ul-� ❑
2 Control Panel equipped with Timer/ ETM ',Counter- -
n
a Pump installed in ❑ Bucket or ['n Block or ❑ Other _
L rj1 oats or ❑ Transducer
Pump Make/Model 11i1 �OYAII{ l C. 11•0 tQ 0
a. Tank draw down 1 in/min Pump capacity I - gpm Squirt Height 3 � 12
a
Pump on time.'11/11 n L1O S e -- Pump off time q hrs Daily flow set at /-42r qpd
updated 12/7/2015
MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel #
RECORD DRAWING
❑ Drainfield&manifold
orientation&layout
wldimensions for
re-location.
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
placement
❑ Location of buildings
existing/proposed
❑ Observation ports,
clean-out locations.
&manifoldsld-boxes
❑ Location of wells,
surface water,roads,
&waterlines.
❑ Reserve area(s)
❑ 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 containeC on this
form and attached Record Drawing is accurate. form and attached Record Drawing is ac rate.
/17)/ — (R I -f Z t 2-L
Signature of Installer Date (5, -3 C ✓
0)117 CLVVIO 1/N —rho Kitf,s0
Printed Name of Signee S�$'tt 0 z
,r , „
MASON COUNTY PUBLIC HEALTH _.1 5100273 tic
The undersigned approves this Installation Report and O? IAMES.R.HUNTER _'
Record Drawing on behalf of Mason County Public itc* b pESt("*ER
Health: EXPt S: 03/22/2,
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 updated 1282015
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