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HomeMy WebLinkAboutSWG2021-00113 - SWG As-Built - 2/8/2023 . IJLl FEB 0 2 2023 - By RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG 20 Z I — 00 113 Assessor Parcel# 3 i tit 0 I y 0D 13 D Applicant Name AA;citiLd i kC. ;A S -c4( Subdivision (Name/Div/Block/Lot) Applicant Address .3724 5;nn v-rs Pic.) .lta CmSV City, State, Zip Tw.,,;�1.-�1 w p, 4851 2. Installer Name 176 vi 3 V; I I,el e-S Site Address l`-t 51 St .14bke 1 /. lei Designer Name kb,;., ji(4,5 e,..) INSTALLATION CHECKLIST `i Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair ' System Type ,S Inca 1/nc,,, PreSSw-- Pretreatment Type Ni-t Ws,t-c/ >5 ft.from foundation? - - ❑ N/A Ki YES ❑ NO >50 ft. from wells? - {�-(� �� �i.- ❑ ] ❑ Z >50 ft. from surface water? - '` `�' �-i i - ❑ ® ❑ HCleanout between building and tank? - ,`i --E-B-0.3-z-H3--t�i - El El ✓ Tank baffles present? - -,1 S• - ❑ E ❑ f' 24"access risers over each compartment?-----4 ❑ f 0 W Effluent filter installed?- - 0P ❑ Septic tank size( CAR gal Manufacturer s Cki J d iU!, . 4— SD-box water level and speed levelers used? - - `® N/A ❑YES 0 NO DO Manifold/D-box accessible from surface?- - 0 El oil Check valves installed? - - ❑ ❑ 2 a2 Transport Line Size 2 Schedule/Class SCt 90 Bedrooms installed(check one) ❑ 2 0 3 t[4 ❑ 5 ❑6 >10 ft.from foundation?- - ❑ N/A N YES ❑ NO CI >100 ft.from wells?- - ❑ M ❑ -1 >100 ft.from surface water?- - El ❑ u. >10 ft.from potable water lines?- - 0 R 0 tid Z > 5 ft.from property lines and easements?- - CIElce >30 ft.from downgradient curtain/foundation drains?- - ❑ ® 0 ▪ Drainfield level and observation ports present - - 0 ® 0 m Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 21 ❑ Pump tank setbacks consistant with septic tank?- - ❑ N/A ® YES El NO ZPump tank size 1100 gal Manufacturer ,/� *.otA4e1 ►"�4CC_ L- <- 24"access riser(s)and accessible from surface?- - El � El( a. Alarm or Control Panel Installed? - - 0 23 0 • Control Panel equipped with Timer/ETM/Counter- - 0 N ❑ tZ Pump installed in 0 Bucket or 54 On Block or 0 Other G. Pump Make/Model I- L Co Z- 1"t / 1"1 - IN Floats or ❑ Transducer RTank draw down C . / in/min Pump capacity J a L gpm Squirt Height y ft Pump on time li' li2 AA Pump off time 6 !DO lif,s Daily flow set at -1 2/O gpm revised 122/2014 RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING Drainfield& manifold orientation • &layout in Trench/bed dimensions and critical distances within layout Septic/pump tank placement t6Location of buildings Observation ports& clean-out locations dLocation of wells, surface water,& / roads U Undisturbed native soil between trenches 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 01 In 'ROY/y Signature of Installer Date F Ag~�^ J rw �uv� II; Lg t Printed Name of Sgnee 'fl 13 is • MASON COUNTY PUBLIC HEALTH 0 C The undersigned approves this Installation Report and • Record Drawing on behalf of Mason County Public / ��NAI.E Heatt 117 ?CZ I 97/(72-'3 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 . e.1/22/2014 d.e•116r.1w•qu�uay Zice€VM' No Mla of 'a l...d 1 ww98.S9SZ lecL) MS AV%VOL fltOP 11411 .via Ml.La1.1S [R[ue•wt 1• ONId33NI9N3 ill° $ _. ... v..s . * , S3HJf1HWd31 r' fyy 11i i 4ar4o VM'Nwwp u°seyl tH„ a E i_ -- p,..oOuuwtup poaaa agdag In3S ; m a1 .... a�1.....o _g -/+.98Z Q yt O © \ !F H1 Chi 7Z...7 CM / it Fi L',' i si 0 ; ts ei e 4*. --- F. ei&V,, ' i . 1§ il • IOs II I'1 .`' i I • : : • ' --i11 1 1 ! +SBZ `� el S CaFc _ w �: __IS t o t � 5 5 s 8 _ kg 2 1 i ! ;i is i i G FIgv E. m 11 I— M 13 • a -4- ( • i Cr. r.L-J 5Z � al � e a W U_ 0000000000 1!)J d• v 0 Z L fH: -: '. c, CC L Q Fl L. a 8 2 0) LL e . 5 p 3 U li 91s a w a U .§ a .2 Vzg- P m 8 "90 g§ wi Gi i 3 �. IJU 1 + U);� §03 � p 1 i§ wW i i1116 61 1 a4 b A ff ' T gg3iik