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HomeMy WebLinkAboutSWG2021-00223 - SWG As-Built - 10/12/2022 (2) 4 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number .SWG 20 Z I aC)z Z 3 Assessor Parcel # y 2--Z )(, -5 z r-oaf.-Z.Z Applicant Name ,)f ccw5 v)P/ Subdivision (Name/Div/Block/Lot) Applicant Address 9 CD " 6 (' Z P', 12. Lec- 1-2 Z City, State, Zip �u k kk 0 �1 Installer Name y►'LLuh S-"`'""7 1 21� Qr //• � Designer Name �(. 5 • Site Address �'I /� 9 INSTALLATION CHECKLIST 0 Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type 5-&ff, ' Pretreatment Type >5 ft. from foundation? - - �-�-��' —,_.,- N/A{7 0 YES � NO >50 ft. from wells? 17� �L J z >50 ft. from surface water? - - DC Z 2 Z1 El < Cleanout between building and tank? - - - - 1012 0 .0 ❑ U Tank baffles present? - -\ - - - ❑ © ElB P 24" access risers over each compartment?- Y - - - ❑ 2. ❑ a W Effluent filter installed?- - ❑ [.c] ❑ cn Septic tank size 1 7U0 gal Manufacturer_ tip ex ,k✓t1 0 D-box water level and speed levelers used? - - 2 N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ 12f ❑ LL m2 Check valves installed? - - ❑ R] ❑ 0< 11 E Transport Line Size 2 Schedule/Class S u 10 Bedrooms installed (check one) (2I)2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A [AYES ❑ NO >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - ❑ K ❑ ti >10 ft. from potable water lines?- - ❑ ® ❑ Z > 5 ft. from property lines and easements?- - ❑ Q ❑ a ❑ ❑ � > 30 ft. from downgradient curtain/foundation drains? - - g] • Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or lg,Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ®.YES ❑ NO • Pump tank size Q j O gal Manufacturer 1-c.q r rY`--v-"' < 24" access riser(s) and accessible from surface?- - ❑ L' ❑ ~ Alarm or Control Panel Installed? - - ❑ a ❑ a E Control Panel equipped with Timer/ETM/Counter- - ❑ Et, ❑ m a Pump installed in ❑ Bucket or ®,On Block or ❑ Other a.• Pump Make/Model 11-72r-k\ 2 C) ❑ Floats or gTransducer 2 Tank draw down I in/min Pump capacity Z ui qpm Squirt Height -7.-'5" ft Pump on time 1 hrr\ 1-15-1•(k-- Pump off time 1 7 t, L "s"\- Daily flow set at 'Zy 0 gpd Updated 12/7/2015 RECEIVED T MCPH RECORD DRAZS UO pgr JAN 3 `f�,s2 or Parcel# tlZ2/� -5Z_. 06 ) ��' �l lfbet/AWltle- Street -Drainfield&manifold NOV 0 4 2022 ...--N e2 orientation&layout MASON COUNTY ENVIRONMENTAL HEALTH Q `= ``�` �� w/dimensions for / %\\ 1 re-location. RET aoo '� �}. Trench/bed �-�� N � � ©� dimensions and _ �— �.`—' i critical distances ,��v O Q p within layout \ ��Septic/pump tank i 1 placement `� 1 . Location of buildings ` — (i . existing/proposed (5( v\ l/� Observation ports, \ clean-out locations, i'4- • &manifolds/d-boxesfyi Location of wells, NG( , surface water, roads, ��� —1 t &waterlines. \,' ' lEi Reserve area(s) 1� `. _vv ita .North ArrowI ' `'�. i-i, 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 cord Drawing is accurate. form and attached Record Drawing is accurate. Signature iif Installer Date 0 �� C10 0 VO I RA-zZ =I, �h - l Printed Name of Signee 71 MASON COUNTY PUBLIC HEALTH /ice f •F4, e .- The undersigned approves this Installation Report and :A , . `w" Record Drawing on behalf of Mason County Public 4„ :o?`.. R! a'`, t�'` w-. Health: :.•.Ir., .r,�ar.�:.;::i _ u 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 17/7/2015