HomeMy WebLinkAboutSWG2021-00312 - SWG As-Built - 10/2/2023 RECORD DRAWING (ASBUILT) pg. 1 Je. MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2-0 1. ( _ vc•.; :31'i- Assessor Parcel # �'L0 2l -S" - ( vc) S
Applicant Name jAv S 0.l - A Subdivision (Name/Div/Block/Lot)
Applicant Address 30-Zl a16 -it- - b bI-. , Su,) L,2 Si‘_,L2 :- r i3 `-0C - 3 T S
City, State, Zip \/60JCr60jin LA/A. C e 67(- 1 Installer Name 3i LL. AA C.--rv1. A- _
Site Address ZZc; v SH1/44.t.:C1 --ST b 1-Z Designer Name J kA. 1}uv-tsvl
INSTALLATION CHECKLIST
Full System Installation ❑ """Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type �V lA Pretreatment Type
>5 ft. from foundation? - - ❑ N/A [ YES ❑ NO
>50 ft. from wells? - -- - ❑ ❑
Z >50 ft. from surface water? - - El El. El
FQ- Cleanout between building and tank? - - ❑ Et
U Tank baffles present? - - ❑ 12i ❑
E- 24" access risers over each compartment?- - ❑ [ ❑
a
W Effluent filter installed?- - ❑ Inig El
cn
Septic tank size l 263 gal Manufacturer SN.N►�,.�
Cl D-box water level and speed levelers used? - - ❑ N/A [RYES ❑ NO
0O Manifold/D-box accessible from surface?- - CI [f El
mZ Check valves installed? - - CZIN LI ❑
0<
E Transport Line Size - Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑ 3 1714 ❑ 5 ❑6
>10 ft. from foundation? --- JUT
r ❑ N/A YES ❑ NO
kl
0
>100 ft. from wells? -r �-1� -� ❑ ® ❑
W >100 ft. from surface water? - - ❑ I) El
>10 ft. from potable water lines?- SEP 2 0 Zp23 - CICIZ 5• > ft. from property lines and easements?- -
ce > 30 ft. from downgradient curtain/foundation drains'? - - -----= ❑ [4 ❑
0
Drainfield level and observation ports present - - ❑ X ❑
cel,Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ IA, ❑
Pump tank setbacks consistant with septic tank? - - K N/A ❑ YES ❑ NO
• Pump tank size gal Manufacturer
Q 24" access riser(s) and accessible from surface?- - 14 ❑ ❑
H Alarm or Control Panel Installed? - - ❑ ❑
n. C� ❑ El2 Control Panel equipped with Timer/ ETM /Counter- -
D
n- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
n'• Pump Make/Model ❑ Floats or El Transducer
a.
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpm
revised 1/22/2,^,1
•
,RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
O Drainfield&
manifold orientation
&layout
El Trench/bed
dimensions and
critical distances
within layout
O Septic/pump tank
placement
• Location of EL. A-r—cA-C k-lt Li-{),
buildings
Observation ports&
clean-out locations
III Location of wells,
surface water,&
roads
0 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 an ttached Record Drawing is accurate. form and attached Record Drawing is accur e.
(M 4-7a7---j 9 -I 4-z 3
Signature of Installer Date ?—
e- Z 3
4r
Printed Name of Signee -sr' f 1 Z lei
MASON COUNTY PUBLIC HEALTH 71' ~s t i3 zr),1
i O, AM[S R.HUNTER "?11
The undersigned approves this Installation Report and �, �
Record Drawing on behalf of Mason County Public N' itCE*iSED bESK.NER �I
Health: EXPf S: 03/22/ti
_79- 001)5Y)1 Y42/73
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
revised 1/22/2014
' _.__Wc_ -0c.f..asIS'f- IA— —..--*
\ -,,,‘, ________
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APPROVED
` 'v --S-Ctla- .° 4_ -'-- -0 -7 OCT 02 2023
j t) MASON COUNTY ENVIRONMENTAL HEALTH
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— EXRf'Es: 03/22/L
•
•
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JIM HUNTER 8. ASSOC. conrrciACToR
P.O. BOX 162 OLY, WA 98507
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753-125 L. AA L rL.d .t4 L
INS . .LL c.ATE i-t1 - L
RECORD DRAWING S'-TE AC)1=,RESS/LEGAL
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