HomeMy WebLinkAboutSWG2023-00204 - SWG As-Built - 11/15/2023 11•
RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number _ ZOOS COWL! allat 3a3/{6-rj0 - oco,1.3
Applicant Name 7ddq t ramai/ 7) jJ A/ . Subdivision (Name/Div/Block/Lot)
Applicant Address id Qne,U67 Candace l6 rWZ3,J /C3 M• r-1'leh.
City, State, Zip I:II uk}dk p u-ef, 9a55 Installer Name 7oe. r—a7 in
Site Address Na0c 1-4MCi Designer Name A. /1.4-17)
INSTALLATION CHECKLIST
O Full System Installation V Tank(s)Only Drainfield Only ❑ Repair ❑ Other
System Type ‘-7)Id 45
V�L Pretreatment Type
>5 ft. from foundation? - ❑ NIA p/ YES ❑ NO
>50 ft. from wells? - - ❑ 2] ❑
Z >50 ft. from surface water? ❑ 0 0
F• Cleanout between building and lank? " ❑ El 0
U Tank baffles present? - ❑ 0 0
H 24' access risers over each compartment?- ❑ ® ❑
a - E 0 El
W Effluent filter installed?
fn
Septic tank size tic?) gal Manufacturer /4.,ferga),,/
0 D-box water level and speed levelers used? - ® N/A ❑ YES ® NO
eO Manifold/D-box accessible from surface? ® ❑ m
CQ Check valves installed? - M ❑ 0
f Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 Commercial/Other
>10 ft. from foundation? - N/A ❑ YES Eg NO
G >100 ft. from wells?- - ® ❑
W >100 ft.from surface water? - ® ❑ E
a >10 ft. from potable water lines?- - ®p� ❑
Q
Z > 5 ft. from property lines and easements? W ❑
K > 30 ft. from downgradient curtain/foundation drains? - - ® ❑
En
Drainfield level and observation ports present - - ® 0 E
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ® ❑ 0
Pump tank setbacks consistent with septic tank? NI N/A ❑ YES Lel NO
`t Pump tank size ,/ gal Manufacturer /
Q 24" access riser(s)and accessible from surface? EF ❑ 0
d W]
Alarm or Control Panel Installed? ❑ 0
2 Control Panel equipped with Timer/ ETM/Counter P ❑ E
7
Cl- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other /l)aR.c
1 f Pump Make/Model MO-IC ❑ Floats or 0 Transducer
/
a. Tank draw down / in/min Pump capacity / gpm Squirt Height
a ft
Pump on time / Pump off time / Daily flow set at / gpd
upoaled wrams
MCPH RECORD DRAWING (ASBUILT) pg. 2 IfrMPOSSIFt
RECORD DRAWING
❑ Drainfield&manifold �� 7(0/
orientation&layout Sac rrA
w/dimensions for
re-location.
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
placement
❑ Location of buildings
existing/proposed
❑ Observation ports.
clean-out locations,
&manifolds/el-boxes
51 Location of wells,
surface water,roads,
&waterlines.
❑ Reserve area(s)
Vg 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 l 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 attacifRecord Drawing is accurate.
sit I
c 0 IDI24' 7)
Sign ture of Installer Date i f
Fits, ,A .ramL.;tyff
Printed Name of Signee 'ASC St 'mfff
ap`',°NTNONr Q W EN Mir ff
1007.25
MASON COUNTY PUBLIC HEALTH y t C`;:D'li; ME'#"
The undersigned approves this Installation Report and ip re • •-zaL
Record Drawing on behalf of Mason County Public
Health:
( Ift-/a —
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 updated unrmts
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APPROVED / ‘:..,
NOV 15 2023
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