HomeMy WebLinkAboutSWG2021-00670 - SWG As-Built - 6/28/2023 RECORD DRAWING (ASBUILT) pg. 1 C.C. MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG c n o l oe6 7c) Assessor Parcel# LI 2 2 %5/2 3 o l 3 l
Applicant Name l/ , (ti e. (a t-) Subdivision (Name/Div/Block/Lot)
Applicant Address r'0- 9-6 'K Z( 1-
f3
City, State, Zip Vejrn 6,04 9 8`t 9'7 Installer Name Jc<--ke-- Go( , Cr-s./Jci , 11 1.6.
Site Address ,3.i'I 10 5 anc.!'e D r Designer Name Adam I--( i_vv1 .p, l
INSTALLATION CHECKLIST . . .
JJ Full System Installation El Septic Tank Only El Drainfield Only ❑ Repair
System Type S(k1y1-r,r too..c,4. Pretreatment Type
>5 ft. from foundation? - s q 9- ❑ N/A IN YES El NO
>50 ft. from wells? - - Cl 2 ❑
Z >50 ft. from surface water? - - {f-?63---- ❑ I ❑
HCleanout between building and tank? - ��� - ❑ ® ❑
O Tank baffles present? - ___ .,,_ ❑ LE ❑
a24" access risers over each compartment?- BY - El ® El
W Effluent filter installed?- El CI
cn Septic tank size 12.3 C gal Manufacturer �Y) e.r
1
5 D-box water level and speed levelers used? - - g N/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- - El El CI
Q a Check valves installed? - - 0 LEI CI
t1
* Transport Line Size a Schedule/Class �GL �`
Bedrooms installed (check one) ❑ 2 X3 ❑4 El 5 ❑6
>10 ft. from foundation?- - ❑ N/A Rf YES ❑ NO
O >100 ft. from wells?- - ❑ U] ❑
W >100 ft. from surface water? - - ❑ El ❑
u. >10 ft. from potable water lines?- - ❑ ® ❑
? > 5 ft. from property lines and easements?- - ❑ ® ❑
> 30 ft. from downgradient curtain/foundation drains? - - ❑ Et ❑
i 0 Drainfield level and observation ports present - - ❑ El ❑
El Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A 14 YES ❑ NO
Y Pump tank size I I C?t2 gal Manufacturer Y- (1 1-+Y--ac,--1-0 v-
• 24" access riser(s) and accessible from surface?- - ❑ EN ❑
I—
Q. Alarm or Control Panel Installed? - - ❑ 121. ❑
• Control Panel equipped with Timer/ETM/Counter- - ❑ 12 ❑
n- Pump installed in El Bucket or in On Block or ❑ Other
n"• Pump Make/Model S- f<Inn'rt\ 61. 5w /5.2- 000Q a Floats or ❑ Transducer
ET. TanK draw down 2 inlmin Pump capacity o gpm Squirt Height Qcif YI ft
Pump on time l . 2 yi-►.r Pump off time Li m, Daily flow set at L(L( gpm
revised 1/2?/2014
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
i
RECORD DRAWING
• Drainfield&
manifold orientation
&layout
• Trench/bed
dimensions and
critical distances
within layout
0 Septic/pump tank
placement
Location of
buildings
El Observation ports&
clean-out locations •
Location of wells,
surface water,&
roads
Undisturbed 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
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
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 certify that all information contained on this I further certify that all information contained on this
form and attach d Record Drawing is accurate. form and attached Record Dra ' is accurate.
(A - \Q4 2
jlure of Ins(t/al�ler Date .►:�.' .'•'�:�
Printed Name of Signee , .>.,� ;:i;� ;.'•:�
MASON COUNTY PUBLIC HEALTH 510U412 �-
$—
The undersigned approves this Installation Report and i ADAP�1 J..HUNTER•I:ii.l•n;l':il{�
Record Drawing on behalf of Mason County Public ��
Health:
fzvlZ3
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 1/22/2014
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