HomeMy WebLinkAboutSWG2015-00205 - SWG As-Built - 3/2/2016 PCrCe/ : OO /$OO IgV
RECORD P — 'WING (ASBUILT) pg.
1 IUTASCMMUUBLIC HEALT
PARCEL IDENTIFICATION LiV: I
A/�sor Parcel # v
fjermi jmb- SWG ,�- d�
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pfican Nam- �Z-[(�,i(, a�4lZt ��Ratio[ Subdivision (Name/Div/Block/Lot)P(,ar a( S�ij'�.-/
t.• •ddress led E. k) 11C.lt kJ I LJG{ •
ASG
ity, State, Zip S krLTow1 , (it)A •�1�',S if Installer Name Act:4kC,e bXi-a t),r.-ri
Site Address IAA 1 (...O. { cLA1- ltid Designer Name ?e-mash Pf'c-Ja.yr 1.4
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Pretreatment Type
>5 ft. from foundation? - P - K N/A OYES ❑ NO
>50 ft. from wells? - -- - - El ria ❑
Z >50 ft. from surface water? - - El El®
< Cleanout between building and tank? - - El ® El
Tank baffles present? - - ❑ Fit El
d24" access risers over each compartment?- - El rsr CI
LIJ Effluent filter installed?- - ❑ ❑
co
Septic tank size IZ P gal Manufacturer [4ti"4 eriercot I. - G4tS i
C) D-box water level and speed levelers used? - - N/A El YES ❑ NO
O , . i old/D-aox accessible from surface?- - El t5d ❑
O uL
m 2 Check valves installed? - - ❑ 10 El
°Q �O
2 Transport Line Size Z Schedule/Class
Bedrooms installed (check one) Fr 2 ❑3 ❑4 ❑ 5 El 6 ❑Commercial/Other
>10 ft. from foundation? - pi-o pSEV - ❑ N/A YES ❑ NO
CI >100 ft. from wells? - 7S r t 14-g t.4►0c45 - 53 ❑ ❑
W >100 ft. from surface water? - -
Elti >10 ft. from potable water lines?- - ❑ I3 El❑
Z > 5 ft from property lines and easements?- - ❑ IA El
d > 30 ft. from downgradient curtain/foundation drains? - - ❑ [g. ❑
0
Drainfield level and observation ports present - - ❑ rg ❑
❑ Graveless chambers or Clean gravel used? (check one)
Proper cover installed over d infield?- - ❑ IA 0
Pump tank setbacks consistant with septic tank? - - ❑ N/A YES ❑ NO
• Pump tank size I WC) gal Manufacturer 17441i
(Wet 4-AA. pg. cA S 7—
Q24"access riser(s) and accessible from surface?- - ,❑ V El
1`
a Alarm or Control Panel Installed? =-1" -Er-QF- E ia`�1'f` � 2 El
Control Panel equipped with Timer/ETM /Counter- - El R ❑
4- Pump installed in pl Bucket or ❑ On Block or ❑ Other
CI-• Pump Make/Model 0-b Z ZE,P(LASr2 Floats or El Transducer
ct
Q. t
Q. Tank draw down Z '� in� Pump capacity 14? gpm Squirt Height LI ft
Pump on time Alt ram f I14l 4 Pump off time 4.h.es Daily flow set at CC-10 gpd
Updated 8/32015
Printed From Mason Count.y DM8
Printed from Mason County DMS
fe
t MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel # .0102.005 S 0 l
RECORD DRAWING
"Drainfield&manifold '—
orientation&layout (e- -ci l; 7,'„.'tr
w/dimensions for l J6
re-location. ,',4" +W aSe l..- M Ate,, on Sas dA�sn T S
�Trerch/bed "� << w �'�� o� r. 0= rpm 9 Ait tJaS
dimensions and J r
critical distances N 2 T4' r� S J
within layout �� �r MM♦"
�SepticJpump tank ��fr 2.41� '
placement loot,4A(
l k— '
0 ZQ __.
®' Location of buildings
existing/proposed
/
Observation ports. f
clean-out locations. 50
&manifolds/d-boxes
Location of wells, pr,..„ d`O
surface water,roads.
� �
&waterlines. ^^A td. Fa
gir Reserve area(s) i
North Arrow
1 \??Al$vt‘ (
If the designer or installer feel the need for additional information/comments, it may be attached.
il 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
I further certify that all information contained on this I further certify that all information contained on this
form an ttached Record Drawing is accurate. form and attached Record D�`ng is accurate.
Signature of Installer Date � �+V.
A(G_.---, K„7-, 0::-.1
Printed Name of Signee J 148=O GREG .WALTERICK . la
- . f
.•.- I NER 1
MASON COUNTY PUBLIC HEALTH 14 AO ik , '.���r.,
The undersigned approves this Installation Report and t,
Record Drawing on behalf of Mason County Public Cr4
Health: Z t ‘O
L
r 3 Z1 IL
1
Signature of En ronmentai 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 Update()12 122014
Printed from Mason County DtvMS