HomeMy WebLinkAboutSWG2011-00196 - SWG As-Built - 6/5/2012 30 L - - (40 ` 3D_. ,
R_D DRAWING (ASBUILT) Mason County Public Health
PARCEL IDENTIFICATION
Assessor's Parcel# Z� ""'��:— 53
Permit Number SWG aa!/ — CO/i6 we ve-DigitNum
�fj b 5 c O l7 Subdivision
Applicant's Name (Name/Division/Block/Lot)
Applicant Address Po BD X 2 G / Installer's Name f 0,1,tt/Si)ld < , •
City,State,Zip , cciat,7 OA 4 ___,..it.,V.4 Sif Cif Designer's Name 54.44
ii-
INSTALLER CHECKLIST
N/A Yes Prior to Completion
I. SEPTIC TANK
>5 ft.From foundation?............................................................. ❑ t7 0
>50 ft from wells? ...................................................... ........._ ❑ 0 0
>50 ft surface water? ...................................................m.......... ❑ J' 0
Building stubout to septic tank: cleanout if not 1-2%? ❑ P ❑
Baffles intact and clean?................................................ ......... ❑ AI 0
Dividing wall intact _............_ 0 tif0
Risers installed for acces 9........................................................ 0 0
Screen basket uent fi to installed?(circle one) .................... ❑ c4 ❑
Tank size: I2.07 ., anufacture: IC tit 4 C.o.C N-rr
II. D-BOX
Leveled with water? 0 0
Speed leveler used? •• ❑ PI ❑
III. DRAINFIELD
>10 ft from foundation? 0 t® 0
>5 ft from property lines and easement lines? 0 51 0
> 100 ft from wells9 0 151 0
> 100 ft from surface water? 0 Vf 0
>10 ft from potable water lines? 0 Pil ❑
Laterals level to±I inch&end caps present if not looped? 0 al 0
Gravelless chambers utilized? eair 0 0
Gravel clean,properly sized,and proper depth'? ❑ l ❑
PRESSURE SYSTEMS
1 Sand quality ASTM C-33? ......................_..................._... 7 0 0
Head height uniform >24 ' s? Actual head height ❑ ❑
Clean-outs servation ports pr ent9 o VI o
Mound: Side Slope : 0 ❑ ❑
Owner informed electrical connections must be made by
owner or licensed electrician and inspected by L&I?............. y 0 0
IV. PUMP/PUMP CHAMBER
Pump make ; Pumpnode P ❑ 0
Chamber size gal; Manufac [�l ❑ ❑
Height of pump off bottom of pum ch er inches
Pump chamber draw-down gallons per inch per minute
Pump capacity gallons per minute
Pump controls:Timer,Elapsed Time Meter,Counter?(Circle all l ❑ ❑
that apply). If timer: Pump On Pump
Off
Riser installed for access?...................................................... . ❑ 0
Alarm installed?..................................................................... f41 0 0
WTl a ,`0 p r fl at -4-0 i38� Roves s.-'`^.".'"�
- RECORD DRAWING 1
CHECKLIST l yb ,db
fir Drainfield& 'c � oat)il-
Li- ��R "^ '�
1
manifold orientation 4ovS8 L
&layout
. Trench/bed — — —
dimensions and htut,......i1
critical distances — -st S,Sil-tom 17oofof 1�within layout A R�3'>1 2c.v-f,rs,1`h --'� 'a G° N. t0rgii
Septic/pump tankl�
placement
D4o
ER Location of • tt" Giti?pro psfe`rl-ti41 r risk's' r
buildings I
L .roTat
gr Observation port&
clean-out location N
'1 Location of wells& /
roads
1 ( Undisturbed native
soil between
trenches
D North arrow
I • t
t• 3e
c
0
CAUTION:Minor adjustments to septic tank location and drainfield orientation made in the field by the installer are generally acceptable
to both the department and the designer but could in certain cases compromise the viability of.the system. It is the installer's responsibility
to obtain prior written approval from either the health department or the designer before malang any deviations from the design that affect
the system viability. Any deviations from the approved design must be shown above.
CERTIFICATION OF INSTALLATION
Installer: Check a box from Row"A"and"B",sign and date the certification
A. 0 I certify that I installed the system without any In certify that all deviations from the design stamped
deviation from the design stamped"APPROVED"by "APPROVED"by MCPH are shown above.
I MCPH
B. Ar I certify that I contacted the designer and left the 0 I did not contact the designer prior to final cover because the
system open for inspection up to 48 hrs prior to cover. designer waived the notification requirement.
I further certify that all information contained on this form is accurate. I understand that if the information contained herein is not
accurate,there will be just cause for immediate suspension of my installer certification.
ckcl-A----AL(513/•/a-
Sign re staller Date
The undersigned approves this installation on behalf of Mason County Public Health.
4,419 6/sj/2..,
Environmental Health Specialist Date
Revised January 2008