HomeMy WebLinkAboutSWG2021-00217 - SWG As-Built - 6/15/2023 v
RECORD DRAWING (ASBULLT) pg. '1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 1�� 1(J- 2/ % Assessor Parcel # 2 Ot' -30� (1' 6.3 a/
Applicant Name [-)o�c( �,?I "- Subdivision (Name/Div/Block/Lot)
Applicant Address I t ?. e S vu1-t-- 1 S r- -p ;,.. . (o f 1 s p z$ti 3
City, State, Zip 5 4- �� Installer Name CJ'( CO�rj/-! ud(la ,
Site Address 5� Designer Name __,,; Z., Q _r2,,. /i
--:'UEIE
k INSTALLATION CHECKLIST __ _
,Full System Installation ❑Tank(s)Only El Drainfield Only ❑Repair ❑Other
System Type Pj'L fiLs 2- (YI Ov),\._c5 Pretreatment Type
>5 ft.from foundation? - - ❑ N/A 2 YES ❑ No
>50 ft.from wells? - _ ❑ ® ❑
>50 ft.from surface water? - -- _ 0 iT ❑
.- Cleanout between building and tank? - _ ❑ 'g ❑
ITank baffles present? ❑ El P. 24" access risers over each compartment?- ._ __ -_ CICI LU Effluent filter installed?- - ❑ ❑
Septic tank size f y_6C gal Manufacturer_ci,tid �) lCc 1-i/1,
`0 D-box water level and speed levelers used? - - 'g'N/A ❑ YES ❑ NO
00 Manifold/D-box accessible from surface?- El El El
m-2 Check valves installed? ❑ ® ❑
s Transport Line Size X Schedule/Class '11 470
Bedrooms installed (check one) ❑ 2 ®-3 El 4 El 5 El 6 ❑Commercial/Other
>10 ft. from foundation?- - - ❑ N/A ® YES 0 NO
® >100 ft. from wells?- El El ❑
-I >100 ft.from surface water? - ❑ a ❑
LI >10 ft. from potable water lines?- _ CIil ❑
> 5 ft.from property lines and easements? _ _ ._ _ _ _ _ El ❑
> 30 ft.from downgradient curtain/foundation drains?- - -- - - - -- ---- ❑ EI ❑
ni
Drainfield level and observation ports present - ❑ la El
`ff Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- -- _ ❑ .g- ❑
Pump tank setbacks consistent with septic tank?- - ❑ NIA YES ❑ No
Pump tank size /c''O gal Manufacturer Li>ld j7/'?' .ie-'-. - i
Z
r24"access riser(s)and accessible from surface?- - --- -- - CIEl11 Alarm or Control Panel Installed? - - ❑ ® ❑
mControl Panel equipped with Timer/ETM/Counter- - GI �- ❑
a- Pump installed in ❑ Bucket ,or ®'On Block or ❑ Other 0. _
PumpMake/Model f ,� '
� ���, � �1"�D [ 'Floats or ❑ Transducer
0_ Tank draw down 1" 'I I, S in/min Pump capacity 36 gpm Squirt Height (�G ft
Pump on time 'L pi Ili eici Pump off time (e 1-16k;,- Daily flow set at 2.7O gpd
Updated 12l712015
1
1
• IVICPI1 RECORD DRAWING (ASBt.IILJ) pg. 2. Assessor Parcel II
RECORD DRAWING
❑ Drainfield&manifold
orientation&layout
w/dimensions for
re-location.
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
placement
II
❑ Location of buildings
existing/proposed
O Observation ports,
clean-out locations,
!Fp &manifolds/d-boxes
1 ❑ Location of wells,
surface water,roads,
&waterlines.
El Reserve area(s)
• ❑ North Arrow
If the designer or installer feel the need for additional information/comments,it may he attached. i
1 Record drawing may also be on a seperate page attached. No.Pages Attached
CERTIFICATION OF INSTALLATION---
-
INSTALLER I DESIGNER s '
l 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 certif that all information contained on this I further certify that all information contained on this
i form and a the ecorcl Drawing is accurate. 4 form and attached Record Drawing is accurate.
�J t
•
/IV 7 _) �Sr nature of l er Date /�
a i 11
(-1'i.1 5 J�11) I '�/�‘7iyI2.�
I Printed Name of Signee 4i: r/i
MASON COUNTY PUBLIC HEALTH it0'4�P'= �` .��11
g The undersigned approves this Installation Report anddc,i= 22030834 � 1
Record Drawing on behalf of Mason County Public .° 111STIN S RUSSat
IICEN CD DESIGNI'.R
Health: ! A57,5 tt �Sln
:
lta�S cstb EXPIRES o71t'L' L)
it
Signature of Environmental ealth Specialist Date ti
^� _i�— 1— (designer's stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE th'd't':I iamzot,
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