HomeMy WebLinkAboutSWG2018-00186 - SWG As-Built - 3/10/2023 C .0
REC 1RD DRAWING (ASBUILT).pg. 1 MASON COUNTY PUBLIC HEALTH
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A. PARCEL IDENTIFICATION
Permit Number SWG;jO/?-QO/g6 Assessor Parcel # 7ZJ /00076
Applicant Name Tr--)e__ 8,Ar- Subdivision (Name/Div/Block/Lot)
Applicant Address 7gj 1. . I -J UP -rtfitiee,
City, State, Zip ,,s4l pyt IVA q8,5 R J/ Installer Name L 11/ A l u / giVIJ
r
Site Address . Designer Name CoLrti e
jJ Yvl HttiYd-('i"
INSTALLATION CHECKLIST -
- m Full System Installation El Tank(s)Only
n ElDrainfield Only . �0 Repair El Other
System Type L.'2W,r_O-OS - )�fS�.PPC N l�ti r`etreatment Type
' >5 ft.from foundation?•
❑ NSA YES ❑ NO
>50 ft. from wells? ❑ ] El. 'Y' >50 ft. from surface water? - - El
_ ' _. Cleanout between building and tank? - - 0 ,�] ❑
C Tank baffles present? - - 0 X ❑
. I=-: 24"access risers over each compartment?- - 0 ,® 0
•W' Effluent filter installed?- •- El ❑ I]
_ Septic tank size iC eG gal. Manufacturer .-7✓►i i
0. D-box water level and speed levelers used? - - ❑ N/A O&M A NO
(5 Manifold!D-box accessible from surface?- - 0 Cl 0
CQz. Check valves installed? - ❑ )`: ❑
aQ. �� ' 'J
>:::=2 Transport Line Size $Cf' 110 Schedule/Class .fC/i '/0
Bedrooms installed (check one) 0 2 ❑3 IN 4 ❑ 5 ❑6 0 Commercial/Other
>10 ft. from foundation?- - ❑ N/A IN YES 0 NO
>100 ft. from wells?- - 0 0
,,G,,,..�� ❑ 0 El
>100 ft.from surface water? -
.. . >10 ft.from potable water lines?- - ❑ IN El i
> 5 ft.from property lines and easements?- - ❑ . I ❑
> 30 ft.from downgradient curtain/foundation drains? - - ❑ IN ❑
.-. , and observationportspresent - -
... Drainfield level ❑ El ❑
:❑ Graveless chambers or I ' Clean gravel used? (check one)
- Proper cover installed over drainfield?- - ❑ is ❑
Pump tank setbacks consistent with septic tank?- ❑ N/A ►7,4 YES ❑ No
-**.;`Pump tank size aco gal Manufacturer Jr yrie``
,.. 24" access riser(s) and accessible from surface?- - ❑ ❑
{ Alarm or Control Panel Installed? - - ❑ ci ❑
:1: Control Panel equipped with Timer/ETM/Counter- - 0 I ❑
'a P• ump installed in 0 Bucket or IRI On Block or 0 Other
2. P• ump Make/Model 2o&l`L1` �i'�� 0 Floats or El Transducer
��:
. ` T• ank draw down `0 in/min Pump capacity 4 o qpm Squirt Height 2. ft
• Pump on time a, iv I\2' Pump off time le l'..r S Daily flow set at Li 7 0 gpd
Updated 17f72015
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- R
M ,[ :'1 RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel#
r. . RECORD DRAWING-
❑ Drainfield&manifold
orientation&layout
w/dimensions 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.
I 0 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
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I CERTIFICzATION,OF:INS?ALLATIO f'' wr y'; '`
j 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
j and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
1 and Mason County Codes. State and Mason County Codes
1 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 Recor awing is accurate.
/ -
f 1
Signature Fens-taller Date
t1 'd kJ t� �V � V
Printedlame of Signee `` °`w.:„,�` •
f;
MASON COUNTY PUBLIC HEALTH r ��" AO.
The undersigned approves this Installation Report and N. , ��t
q' s R.t±tt;t .4 1+
Record Drawing on behalf of Mason County Public ty{cP.+=r)t?f_Stci •
Health: E\PMFS: 03/22/-L�
r/1 .3/
Signature of EnvironmeY nf�i Health Specialist Date signature and date)g (designer's stamp, s gn n a e)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 12/7/2015
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