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HomeMy WebLinkAboutSWG2021-00656 - SWG As-Built - 5/16/2023 ‘IleGt' RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION se...lameNembreaces=emcomaa.sacial Permit Number SWG aoai -O0c Assessor Parcel# -S LC 7_, S.9O (Co-1 , Applicant Name -�A,_, 0 Subdivision (Name/Div/Block/Lot) Applicant Address R•r, c,liti ? -& S kdre-_ C/-c.s.i City, State, Zip < .4 A c w‹.;. _ /l gC„2_c.,. Installer Name o co Site Address /(,,G (_ 50,1 ,j.t,Jw Designer Name /4 L.,., ..u.,,,�t-Kr-- • INSTALLATION CHECKLIST . •- (a Full System Installationllat ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair System Type 1 J!-1rp Pretreatment Type 1 >5 ft. from foundation? ❑ N/A YES ❑ NO t >50 ft. from wells? tf- •f -�- -\i-C- ❑ 171 ❑ >50 ft. from surface water? - ❑ �7JhCleanout between building and tank? ---- - -A-P'- 9-�23--' [] ❑ U Tank baffles present? - - - ----- [J El CI. 24' access risers over each compartment?- By w~ © El N Effluent filter installed?- � IZ El Septic tank size t f cc gal Manufacturer 144 G el" t- c-..4.t im D-box water level and speed levelers used? - - N/A ❑YES ❑ No �O NlanifoldlD-box accessible from surface?- El El- m Z Check valves installed? - -- ❑ ❑ Transport Line Size Schedule/Class `-W Bedrooms installed (check one) cS.2 ❑3 ❑4 ❑ 5 ❑6 1 >10 ft. from foundation?- -• ❑ N/A VI YES ❑ NO 4 ❑ >100 ft. from wells?- - - 121 El 1 W >100 ft. from surface water? - - ❑ ❑ ❑ tr_ >10 ft from potable water lines?- - ❑ 00 > 5 Q ft. from property lines and easements? El [i] ❑ © > 30 ft.from downgradient curtain/foundation drains? Li El El- - 3r Drainfield level and observation ports present - - ® ❑ 0 ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield? - Cl ,0 El Pump tank setbacks consistent with septic tank? - - ❑ NIA ❑ YES 0 No • Pump tank size 12-0d gal Manufacturer /,t&,,,.v ut.ct.e Q24" access riser(s) and accessible from surface?- _ ❑ El ❑ F- a. Alarm or Control Panel installed? ❑ 0 ❑ • Control Panel equipped with Timer/ETM!Counter- - - - - ❑ El ❑ ci- Pump installed in ❑ Bucket or ❑ On Block or El Other TI/LI(_ - a Pump Make/Model d(Qvt-cZ f F L CJ C S— ❑ Floats or ❑ Transducer Tanl`,draw down < rj in(min Pump capacity ? gpm squirt Height / Pump off time 6, ad-v..... ran ft Pump on time �(1 r ,� Daily flow set at gpm rev- d 1l2212J15 A RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH L RECORD DRAWING 1 Draintield& tl manifold orientation t &layout 1 m Trench/bed dimensions and ° critical distances i within layout Septic'pamp tank placement l[J Location of buildings © Otservation ports& can-out locations e 1 Location of wells, surface water,& roads 0 Undisturt ed native C soil between I trenenes i k 7] 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 1 shown here have been cleared/approved by both and Mason County Public Health and meet all State I myself and Mason County Public Health and meet all and Mason County Codes. . State and Mason County Codes I further certify that all informetion 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. Signature of installer Date € Printed Name of Signee • MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report end 1 Record Drawing on behalf of Mason County Public Health. (trill Olt /2,T 1 Signature of Environmental Health Specialist Date (designer's stamp, signature and date) 1 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE r '4sE.r '.'.5::2r 4 // 7--------- loll(ll1' 0n ^� l) 70 2,r m II N O O 1 �- Z N C m v 70 n• • 0 x 0 o z 3 rn • o 70 CO • o Z D c� o o A O D 73 o 10 In o C Co -13 Z D D Z m I. Z D x x o 9, O cn 70 5 d>rn / Z / �zcn 11� ej o y10 • y. o 0 x. 0 • C G) ► —� v 1,4 0 m oW 414 •J o 0 Z � 111 om rIv m co 1 O S. CO Om C C m C t 1 (T N � ' m 1 �l T _ Im / �o Z ::.:71_----j_____ �� O:0 f � f �� l � � 70 I ui I vv +J .� • ., m o _ m o T S < A M�`nGNnO z 0 m v 1 0 2 0 m 5 x _, 0 m r z p ►—I m 70 Po vrn ' 0 = •O `x a z o CC V. o C IV h xLDp vmn z < n wrnHo o a iv • • "'i_ n " . •.•j �c %'1--Y /h ( ] 7: :4 .4�p co � • • ; , n m V 2 c_ r, a O 4, ac D D D 0 J 0 0 0 g N ro > m 0 0 m (1 (A) N m (p m Dm O m C N 0 Z a Z < m m N m 0 D N a 0 T1