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HomeMy WebLinkAboutSWG2023-0067 - SWG As-Built - 9/7/2023 C,C RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG ZC) .Z- ( -(Xj 1 c Assessor Parcel # I O 4 Sc COO BF Applicant Name L>c.,J ; ()Jo, ( Subdivision (Name/Div/Block/Lot) Applicant Address I(A I 0 b•/ C Lec/4-c,_.4.)(< 1----,_-L.L) k."----, L c.(CLi ;Oy '—e City, State, Zip Installer Name 41 — _ go ct.tL"�gA 4-u z - Site Address (-'c,,,,L_ Lc-v. � Designer Name _�� ,,..,_ `''L 1 u,,ti k c.l' INSTALLATION CHECKLIST Fi Full System Installation 0 Septic Tank Only ❑ Drainfield Only ❑ Repair System Type Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑YES ❑ NO >50 ft. from wells? - -- ❑ ❑ ❑ Z >50 ft.from surface water? - - ❑ 0 0 Cleanout between building and tank? - - ❑ El ❑ U Tank baffles present? - - ❑ 0 0 a24"access risers over each compartment?- - ❑ 0 El Lli W Effluent filter installed?- - ❑ ❑ Septic tank size gal Manufacturer I D-box water level and speed levelers used? O N/A El YES El NO O . Manifold/D-box accessible from surface? ❑ ❑ co, E Check valves installed? - - ❑ ❑ 0 Q Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 jA 3 ❑4 ❑ 5 ❑6 >10 ft. from foundation?- - ❑ N/A El YES ❑ NO CI >100ft.fromwells?- - ❑ 0 -J >100 ft.from surface water? - - ❑ El ❑ S i ,,, t_ W ti >10 ft.from potable water lines?- - ❑ El ❑ Z > 5 ft. from property lines and easements? - ❑ ❑ ❑ W > 30 ft. from downgradient curtain/foundation drains? - - ❑ © ❑ fn Drainfield level and observation ports present - - ,❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield? - ❑ ,❑ 0 Pump tank setbacks consistant with septic tank? - - ❑ N/A DYES Elr 1 ZPump tank size I Z00 gal Manufacturer (-i•c<<- -er µc --s pail N Q 24" access riser(s)and accessible from surface?- - ❑ 0 ❑ o *„4 F—a Alarm or Control Panel Installed? - - El El El Nul c 2 Control Panel equipped with Timer/ETM /Counter- - ❑ ❑ ❑ 1E9 w 0 d Pump installed in ❑ Bucket or ❑ On Block or p Other (r .tP Nul a. Pump Make/Model S r� _3 El Floatsor ❑ Transducer r. ,-3 � a Tank draw down 17? in/min Pump capacity 2() gpm Squirt Height l-''' ft Pump on time - C- c -F-L Pump off time z- H Daily flow set at qpm revised 1/22/2014 RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING • Drainfield& manifold orientation &layout • Trench/bed dimensions and critical distances within layout • Septic/pump tank placement • Location of buildings IE Observation ports& clean-out locations WI Location of wells, P P R,Q surface water,&roads SEP 0 7 2023 ird MASON COUNTY ENVIRONMENTAL HEALTH Undisturbed native soil between J B 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 1 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate. 5 i-ZCO-) Sign ture of Installer Date 4'` (<��Q I 8/31/23 /l co� T 6� Printed Name of Signee A .. MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public alth J' + is• ADAM J.HUNTER '� •�•,:�t•j1.!S iti ltt�fi•'itt7E{i.:. 24 Si at r 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 • g . QQ I1 gg us 'i k Li M FW- 3 Z S g 7 E6 o m j = N Z lLLi rn m w - w O o >Ce CI �4 03 3 r r x. W , qr r= O i 0 ''r,.'.a -d i d 0 a . f W b C ♦.a I .. __ Iv . N LLg �' W ,;, a / 4 a 8 0 • �. •' APPROVE SEP 12023 • • �` _� i MASON COUNTY ENVIRONMENTAL �� HEALTH JBW -•„.. / 8 W I bW.70 iii ' 0000000