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HomeMy WebLinkAboutSWG2022-00092 - SWG As-Built - 6/27/2023 RECORD DRAWING (ASBUILT) pg. 1 C.--C. MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION ' Permit Number SWG ()Ze_ —00 1re.. Assessor Parcel # 2_-ZZ_( — 2.c.:--- ia)T-S Applicant Name Q,.oe cj t.1,4(\ Subdivision (Name/Div/Block/Lot) Applicant Address E 1411, ',e. E-t`dws_ c,u".J-.c'_ V.,sc„* e_-c City. State, Zip . Site ? ( ��(y,�`,Installer Name /1/l tit u` Site Address 3 Sc: 2G..c,L r' e.,: ,r ; Designer Name /J,r,J._, E.c u ,..c�---/- INSTALLATION CHECKLIST Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair System Type_ -Iv frt.- 5\►-e. - 4\M \ Pretreatment Type >5 ft. from foundation? - - ❑ N/A p YES ❑ NO >50 ft. from wells? - .- - - - ❑ IL ❑ >50 ft. from surface water? - ! I A-I I E a -- ❑ (] ❑ Cleanout between building and tank? - I JU� `� ���3 ❑ ❑ ❑ U Tank baffles present? - 1 - ❑ ❑ ❑ a24"access risers over each compartmen ?- - CI ❑ W Effluent filter installed?- By - ❑ ❑ cn Septic tank size 10.J Z- ) gal Manufacturer (-4-40e,c}5 v•�-�—� 5 D-box water level and speed levelers used? - - 21 NIA ❑ YES ❑ NO �O Manifold/D-box accessible from surace?• - ❑ ❑ ❑ CO2 Check valves installed? - - E ❑ ❑ OQ n Transport Line Size Z2( Schedule/Class 'p Bedrooms installed (check one) ❑ 2 3 ❑4 ❑ 5 ❑6 >10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO 0 >100 ft. from wells? - - ❑ El ❑ W >100 ft from surface water? - - Cl ❑ El LL >10 ft from potable water lines?- - - - El 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ © ❑ Q prpe` y CC > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ ❑ Drainfield level and observation ports present - - ❑ 0 0 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ Q ❑ Pump tank setbacks consistant with septic tank'? - - ❑ NIA Z YES ❑ NO Y Pump tank size ) ZCxJ _ga. Manufacturer 1-kx.S j.z,mac.,... 'ce (c,,t r— < 24' access risers)and accessible from surface?- - ❑ e ❑ H a Alarm or Control Panel Installed? ❑ ❑ ❑ Control Panel equipped with Timer/ETM/Counter - - - ❑ (I- ❑ n- Pump installed in ❑ Bucket or 0 On Block or El Other E Pump Make/Model I} y .zit Lac) 21-Floats or ❑ Transducer a Tank draw down Z11 In/min Pump capacity S-0 gpm Squirt Height 4 it ft i Pump on time ? :.L Pump off time (c' (.f/'g Daily flow set at gpm •c;,soa 1.::2_14 RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING E Drainfield& manifold orientation &layout • Trench/bed dimensions and critical distances within layout O Septic/pump tank placement • Location of buildings O Observation ports& clean-cut locations • Lo;,ation of wells, surface water.& roads Urdsturbed native soil between trenches ❑ 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 I CERTIFICATION OF INSTALLATION INSTALLER DESIGNER I certify that l 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 t 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 Record Drawing is accurate. /7.0- -............. --. 6..s-_70-7.3 -._,.._ p;:,-;;,-;;.-.: - _ Signature of Installer Date Z -i7)-t ' 0 111 Ns nnted Name of Signee �.�;• ,-, rti-t:a«.,�,,,,c 1 00"r' MASON COUNTY PUBLIC HEALTH0.�•ti /.Z f...ss1 The undersigned approves this Installation Report and ofv '•ti�1` �.. 5100.112 " i Record Drawing on behalf of Mason County Public • 3""ADAM J.HUNTER %'1I Health: .,. i Irt'niSt':i t51'S'��.xf" """ 1 (2/112/3 Signature of Environmental ,ealth Specialist Date (designer's stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE rcw:rm•22C•. y " a \ CD \ J \ 0o V itt \ IIz ,— T z STQ woMm Ell S NJo --1 _- jp O C C rn N r a n N \ \ NN .. 7S. N\\\\� �NSTRucnONau / \ \ \ \ \ \ �FR \ N \ \ FR N \ \ \ \ \ \ /N A x .... r Q N J 0 , 3 1 \� 0 Z = J C W r W `S W i m m In ' 73 CO CO n -Ix g ,(3,,m ,, C g m 1.) -Ir. OW i X v X t \ 8£Z m m O N O j o v n W O3 OH m C yr.w C Z D D i 3 z s m . :.::7;•-•l'17..V4-;,%.'\,4...,.4 ..,*;\N.. . C O 7 O (1 :.4 w n -` M of w t °m m cn m CO z O o W 3k r D D 2 5 z cn m m N m Z 0 D in -- o rr- C rn O m rn Z m 7 w 73 o D w I Z