HomeMy WebLinkAboutSWG2023-00205 - SWG As-Built - 11/15/2023 •
RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number
2111111100 20S at 3i6-5()-a,o12--
Applicant Name Vol+THNNy c�✓///N✓ Subdivision (Name/Div/Block/Lot)
Applicant Address Po (30k 367 {a'f.Y&/Sco fG 7-1.,,^1423AI Rif✓ w.•-fi
City, State. Zip /I II; uJodp WA, 98555 Installer Name TOP ,CGz/d
Site Address Me9ole coA/C Designer Name /a . aile °
INSTALLATION CHECKLIST
❑ Full System Installation vi Tank(s) my ❑ Dreinfield Only IDRepair 0 Other
rSystem Type 1 !1,. ta I- Y Pretreatment Type
>5 ft. from foundation? - ❑ NIA 0yES ElNO
>50 ft. from wells? - 0 IXI ❑
,Z >50 ft.from surface water? - j ❑ 2 0❑
• Cleanout between building and tank? - 1. - ❑-
✓ Tank baffles present? - ,�;.,
it24" access risers over each compartment? ❑ ❑ E
W Effluent filter installed? - 0 PI
co 7/
Septic tank size I 00 gal Manufacturer � � 1 t- i"`nilHW'a'✓I
O D-box water level and speed levelers used? - ❑ NIA ❑ves 14 NO
J
*O Manifold/D-box accessible from surface?- - ❑ 0
mZ Check valves installed? - 2 0 14
0Q Schedule/Class
5 Transport Line Size
Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 Commercial/Other
>10 ft. from foundation?- ® N/A ❑ YES [(NO
a >100 ft.from wells? - K1 ❑ 0
W >100 ft. from surface water? - - ® ❑
cii
1i >10 ft. from potable water lines? 133 0
> 5 ft. from property lines and easements? - 12 0 2
> 30 ft.from downgradient curtain/foundation drains?-
El 0
• Drainfield level and observation ports present 12 0 4
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfeld? Q ❑
Pump tank setbacks consistent with septic tank? ® NIA 0 YES
ISal NO
Y Pump tank size / gal Manufacturer / r!1
< 24" access riser(s)and accessible from surface?- KJ 0 I- El
a Alarm or Control Panel Installed? - 0 ❑❑
2Control Panel equipped with Timer/ETM/Counter- - .�]
7
C Pump installed in ❑ Bucket or 0 On Block or ❑ Other O fir
d Pump Make/Model MA Aid ❑ Floats or El Transducer
2 / ft
7 Tank draw down / in/min Pump capacity / gpm Squirt Height
O.
Pump on time / Pump off time / Daily flow set at qpd
updated ivriiois
MCPH RECORD DRAWING (ASBUILT) pg. 2 diammiSiM#
RECORD DRAWING
Drainfield&manifold
orientation&layout
wldimensiona for �j r C' E'7 ?rot
re-location. $E�
Trench/bed
dimensions and
critical distances
within layout
CO Septic/pump tank
placement
Location of buildings
existing/proposed
Observation ports,
clean-out locations,
&manifoldsld-bones
iz Location of wells,
surface water,roads,
8 waterlines.
Reserve area(s)
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 separate 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 ; ord Drawing is accurate.
1
Sig di . of Installer Date !3P 9s,Slp
'
�Yj J�
—Printed Name of Signee :y of ••.',l•
;ANTHONY O W EN DEMIERO'�,�t
MASON COUNTY PUBLIC HEALTH _if `C1aw. tits The undersigned approves this Installation Report and C' J ., —to ARecord Drawing on behalf of Mason County Public
Health:.'..'
tI 11I2_3
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 12/16015
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