HomeMy WebLinkAboutSWG2022-00475 - SWG As-Built - 9/19/2023 r 44
RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 'L O L L - 00 y 75- Assessor Parcel# �-2O l 5 Oo? 6 7
Applicant Name (3rc.ci QoL/ Subdivision (Name/Div/Block/Lot)
Applicant Address 7-.01-7 ttic,lkc-r Pc,7k Ra
City, State, Zip Slit) 4-0.1 1 WA I g S-ri Installer Name Tc.vi s V,)i!; nee
Site Address 6 . M - -e.1 PL Designer Name A ch" ,1/w4e/
INSTALLATION CHECKLIST .
X Full System Installation ❑ Septic Tank Only 0 Drainfield Only 0 Repair
System Type GIs ,vn Pretreatment Type
•
>5 ft.from foundation? - r -- 0 N/A ®YES ❑ NO
>50 ft. from wells? - '- U�`+ -- ❑ [r ❑
• >50 ft.from surface water? ----- �' - ❑ (9 0
Z ,
< Cleanout between building and tank i--Sj#•-lr 2-%� 3 - ❑ 21 ❑
✓ Tank baffles present? - - 0 DK 0
a24 access risers over each compartment?-- - -1, , - 0 IN 0
coW Effluent filter installed?- - 0 al
Septic tank size 1900 qal Manufacturer (re..- .i e/ �'-i(_S
D-box water level and speed levelers used? - - N/A ❑ YES 0 NO
QJ
O Manifold/D-box accessible from surface?- - 0 Qg 0
m- Check valves installed? - - ❑ ® 0
04 I, 7J
M Transport Line Size I Schedule/Class
Bedrooms installed (check one) (*in 2 0 3 0 4 0 5 ❑6
>10 ft.from foundation?- - ❑ N/A YES 0 NO
Cl >100 ft.from wells?- - 0 IX 0
W' >100 ft. from surface water?- - 0 2. 0
LL >10 ft.from potable water lines?- - 0 DI 0
QZQ > 5 ft.from property lines and easements?- - ❑ a 0
d > 30 ft.from downgradient curtain/foundation drains?- - 0 ($ 0
0. Drainfield level and observation ports present - - 0 12 0
• 0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 (:N 0
Pump tank setbacks consistant with septic tank?- - 0 N/A CM YES 0 NO
Y Pump tank size 1000 gal Manufacturer Pr'cet;t.r QL.St S
< 24"access riser(s) and accessible from surface?- - 0 IN ❑
F.c. Alarm or Control Panel Installed? - - 0 0
g. Control Panel equipped with Timer/ETM/Counter- - 0 IN 0
Is led in pll Bucket or M On Block or 0 Other
YM�d r l a5 / 20 D 5 I( 0 Floats or Transducer
� c draw down in/min Pump capacity -LO qpm Squirt Height — ft
•J '.''-:. P��ummmpllotf timi3 - I'S Pump off time 4- 41 Daily flow set at qpm
MASON(AUNTY ENVIRONMENTAL HEALTH revised 1/22f2014
DJA
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
❑ Draintield&
manifold orientation
&layout
❑ Trench/bed
dimensions and
critical distances
within layout
• Septic/pump tank
placement
• Location of
buildings
❑ 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
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 and attached Record Drawing is accurate. form and attached R d Drawing is accurate.
lit..--/--s-- *Lki/Z_3 .,.
Signature of Installer Date 2
S kV
�c�,;s r L n c s �, ;�: SEP 19 2023
Printed Name of Signee *Ago '.
ti. . ,,,,.>� MASON c Ty •
MASON COUNTY PUBLIC HEALTH ` `; .0, N EN�VIRONMENnL
\�: ; , DJq HEALTH
The undersigned approves this Installation Report and
Record Drawingon behalf of Mason CountyPublic �G' sJ.HUNTER �,%
v, ADAM J.
Health: LIt;EniSE'tI ESKS'IL,iJEA•"
V VA)
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
reviled 1122f2014
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