HomeMy WebLinkAboutSWG2022-00155 - SWG As-Built - 9/8/2023 V
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RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 1 U L - 0 c) \ \ssessor Parcel# 3%C / ,i
Applicant Name ,.li= _t._>c 4 ;1.� i S Subdivision (Name/Div/Block/Lot)
Applicant Address s '@ Z-l i o'-) h1, -i gct S -`•-►• $)A,.,ct S L..4_s -c(a u--c S' '-,-)-r
City, State, Zip (hoc L S-tveNk i w 4. ' S1. 9 I istaller Name Cr.CGvt")-
Site Address I Log. ki4'-�+ b'z-‘kJH-r ? RUDesigner Name 5 k ii-it,,to---
INSTALLATION CHECKLIST
'Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pretreatment Type / Mt-
>5 ft.from foundation? - �.r. ❑ N/A BYES 0 NO
>50 ft.from wells? - %li s ip i-- -. ❑
!04 z >50 ft.from surface water? - ' �! ► �� � '�;,
Q Cleanout between building and tank? - 1iiL
:$ ❑Tank baffles - •rA""� /
present? t &I ❑
a24"access risers over each compartment?-- -- ❑ ❑
W Effluent filter installed?- I.• _
N \ ❑ 4 ❑
Septic tank size (LSD gal Manuf tuner k��,,,GJ-
19 D-box water level and speed levelers used? - - aN/A ❑ YES ❑ NO
><O Manifold/D-box accessible from surface?- - ❑ - ❑
m— Check valves installed? - 0 Ea
t]<
2 Transport Line Size 2'' Schedule/Class '-ii 1-Jo
Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 0 6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A ® YES ❑ NO
0 >100 ft.from wells?- - - ❑ El
W >100 ft.from surface water? - - 0 ® ❑
ti >10 ft.from potable water lines?- - ❑ ® ❑
z >5 ft.from property lines and easements?- ❑ El
a
ix > 30 ft.from downgradient curtain/foundation drains?- - ❑ )0 ❑
ci
Drainfield level and observation ports present - - ❑ .[ 0
❑ Graveless chambers or Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A Ict YES ❑ NO
z• Pump tank size ), ,OCi gal Manufacturer zjp-,./rict yM ��
< 24"access riser(s)and accessible from surface?- - ❑ ❑
d Alarm or Control Panel Installed? - - 0 2 ❑
2 Control Panel equipped with Timer/ETM/Counter- - ❑ .1--- ❑
m
a- Pump installed in 0 Bucket or E'On Block or ❑ Other
n Pump Make/Model ply etA5 01 e. -7 Moats or ❑ Transducer
d Tank draw down I: in/min Pump capacity/0' ,gprn Squirt Height 36 .7 ft
Pump on time /M,h g_c_ '- Pump off time 1/ ikA.4-5 Daily flow set at 3'n gpd
Updated 12/72015
1
- MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel## Z ISa(9s 1000c, t
RECORD DRAWING
❑ Drainfield&manifold
orientation&layout
w/dimensions for
re-location.
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
placement �C.'
❑ Location of buildings k.c6
existing/proposed
❑ Observation ports,
clean-out locations,
&manifolds/d-boxes
❑ Locationrc oa wells,r
PPROsurface water,roads, VE
1 -'�+"&waterlines. ;�r.
0 Reserve area(s) `""J U 1U23
❑ North Arrow MASON COUNTY E�NVIVIRONMENTAL HEALTH
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 Co s. State and Mason County Codes
I further certify tha I information contained on this I further certify that all information contained on this
form and attac R ord Drawing is accurate. form and attached Record Dra ing is accurat .
Ll/1 �?,
Signature of Installer rDate J
l'�t/-16 sryt,�� .o`k
$ -Z3 -L3
Printed Name of Signee ?..
MASON COUNTY PUBLIC HEALTH fir' ' lc:.
_4.,
The undersigned approves this Installation Report and sl,,,;;r3 s�
Record Drawing on behalf of Mason County Public 0 JAWS R.a•Aff, ER �/.
Hea
f _--� 7.-- N,_ EXIIIIES: 03/22J2—
Si. afef 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 Updated 12/72015 ,
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