HomeMy WebLinkAboutSWG2022-00152 - SWG As-Built - 7/5/2023 i
-goriutlLoU i nS{�.\,P!i!3 2023 N (
RECORD DRAWING (ASBUILT) pg. MASON COUNTY PUBLIC HEALTH
1 I PARCEL IDENTIFICATION
Permit Number SWG 202.2" CO 15i Assessor Parcel # .j Z v ZL_ 5 s C.2-du I
Applicant Name t=tR-i-sU 6 , 6(--I Y Subdivision (Name/Div/Block/Lot)
Applicant Address „0 - ,., .5-, h�,
6 5 ,z c-,z-cci ,— . ;�.-LAtz. .c— -z ,u" - 0 ,fir), it %--.; r 1 ,
City, State, Zip ,A.�1(.:-0-,\-l-wA hJ4 , i e-STe Installer Name 3 t L L vas.c-i.vtZi•-(ii-.L
Site Address vt l cam. iDa..i2-.-"44--t t3,-.! 6 Designer Name �1, .,,,, ti-v;.L--t,,:,it,
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INSTALLATION CHECKLIST
6.Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type N.L SS 0 ?-c; ✓,7 _ Pretreatment Type (L-
>5 ft. from foundation? - - ❑ N/A DYES ❑ NO
>50 ft.from wells? - - ❑ f.:1 ❑
' Y >50 ft.from surface water? - ❑ El., ❑
ci Cleanout between building and tank? - - ❑ [Sr ❑
U Tank baffles present? - - ❑ 0
d24"access risers over each compartment?- - ❑ [Z. ❑
W Effluent filter installed?- - ❑ ® ❑
to
Septic tank size �2S qal Manufacturer 5-/-174v
D-box water level and speed levelers used? - •- - - - - N/A ❑YES ❑ NO
DO Manifold/D-box accessible from surface?- - (] ❑ ❑
oo. Check valves installed? - - Q ❑ 0
* Transport Line Size `2i Schedule/Class SC, ; 40
4
. Bedrooms installed (check one) ❑ 2 CI3 0 4 ❑ 5 ❑6
4 >10 ft. from foundation?- - ❑ N/A [1(YES ❑ NO
>100 ft. from wells? ❑ IA ❑
O
--t >100 ft. from surface water? - ❑ ® ❑
W
u- >10 ft.from potable water lines? - ❑ El ❑
I Z▪ >5 ft from property lines and easements? ❑
OL >30 ft. from downgradient curtain/foundation drains? ( ❑ ❑
• Drainfield level and observation ports present - - ❑ 11 El
4 i [ . Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - ❑ IK ❑ Cri -
fui
IPump tank setbacks consistant with septic tank?- - ❑ NIA KYES ❑ W N
Y Pump tank size /2-'57) gal Manufacturer SK`JG&(-' *—•
< 24"access riser(s)and accessible from surface?- - ❑ EA cz
aAlarm or Control Panel Installed? - - ❑ `=� i
2 Control Panel equipped with Timer/ETM /Counter- - ❑ E] Q
CI' Bucketa Pump installed in ❑ or ❑ On Block or ❑ Other ~
� coW
O. Pump Make/Model !tn.-c,:XL_J AA-& 4. S [Moats or ❑ Transducer
5
a.
a Z L Tank draw down 1--- in/min Pump capacity 620 qpm Squirt Height "A 6 ft
Pump on time �, ,r‘•1..5- Pump off time * tA'C S Daily flow set at C20 qpm
revised 1/22/2014
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
Ej Drainfield&
manifold orientation
&layout
Trenchlbed
dimensions and
critical distances
within layout
0 Septic/pump tank
placement
❑ Location of L -LU\ ! L
buildings '( ,-' n 'tf"
P;
0 Observation ports&
�h
clean-out locations
Location of wells,
surface water,&
roads
0 Undisturbed native
soil between
trenches
0 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
(further certify that all inf mation contained on this i further certify that all information contained on this
form and ched R rd Drawing is accurate. form and attached Record win is accurat
s/,,/L3
Signature of installer Date . •
4� Li.LAMA-. Q. .s-r�-VN�. �� .�f c� - I - 3
Printed Name of Signee \e .,, �.21i.4
MASON COUNTY PUBLIC HEALTH A:"" ?` /J'r+t
4, Stu:>73 '£� tt
'
The undersigned approves this installation Report and U�" ItP-tF;A.;,c.faTER ++
Record Drawing on behalf of Mason County Public itc 'T`. c.1� 4:-��``'I
it
Health: • , .t.PMtS: 43/2.2/2, •
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
revised 1i22r2014
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ROVED
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:__2 JUL 0 5 2023
_Iv ! MASON COUNTY ENVIRONMENTAL HEALTH
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f O LAMES R.HI,I S.'.
i bat" DESIGNER t
`"_���� la ������',, JIM HUNTER Si ASSOC. cc,Nu-FucroR
MPfRES: 03/22/
P.O. BOX 162 OLY, WA 98507 /a1\,,k,.„ ,N,C.,---nat,to4.L,
753-1225 INSTALL C>ATE S..1.1.,rN of
RECORD DRAWING SITE ADDRESS/LEGAL
OWNER- ,W., `,0`iit-^erE FINAL rATE S'..,r.' ..3
TP# 3 Z o2.1- S S- ' '^'oci 1 SITE•I S:*1 4v,.r..1,"'ta,AsZ.