HomeMy WebLinkAboutSWG2022-00361 - SWG As-Built - 11/3/2023 _ r
RECORD DRAWING (ASBUILT)
pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION Permit Number SWO ZMZ�1Z�> 0 0 g sso
f _ Asser Parcel# 3Zoz1II-'5 (�q �V/� 1 �I
Applicant Name T hyv -4-'vt Subdivision(Name/Div/Block/Lot)
Applicant Address rco E M<lcr-e* Dr .4 kArncesE" 3ck &-(-- t
City,State.Zip 5 i Lvt4 Installer Name V 4-L. C--
Site Address ,-or Z I Designer Name /tA.ilit (—LA
INSTALLATION CHECKLIST
gl Full System Instafetion ❑Tank(s)Only 0 Dralnfidd oar 0 Repair ❑other
k System Type P'd1 J/V Pretreatment Type /
y >5 ft.from foundation? • -, El NIA L:1 ❑ NO
>50 R from wells? - - 0 0
Y >50R from surface watatl - - 0 0 0
4 Cleanout between building and tank? - L ❑ �+ CII- Tank baffles present? - • 0 ❑
24•access risers over each compartment?- h - ❑ 0
N Effluent Mar Installed?- ❑ - ❑
Sepik tank sae 17 °4) sal Manufacturer N<"c h,.4h,/c
9 0-boxwamr level and speed levelers used? • - [a NlA Er ❑ NO
C¢LL Manifol/D-box accessible from surface?- r,� 13
d= Check valves installed? - • 0 07 ❑
g Transport Line Size Z i Schedule/Class '-/0
Bedrooms installed(check one) ❑2 0/3 ❑4 ❑5 ❑6 0 CammercallOther I.
>10 R from foundation?- - ❑ WA [FIVES 0 No
9Q ❑>100 ft from wells?- - 0
W
>100Rtrom surfers water? - 0 ❑
tr. >10R from potable water lines?- - 0 ❑
_
a >5 ft.from Property Tines and easements?- - 0 0
is >30 ft.from downgredient curtai&foundatbn drains?- - El0 0
o
Draintleld level and observation pre present- - ❑ [Er- ❑
❑ Gmvefess chambers or Clean gravel used? (check one)
Proper Dover Installed over dreintetd?- - 0 of ❑
Y: _/
Pump tank setbacks consistent with sea tank?- - 0 WA 0 yES 0 No
Z Pump tank size l2 .rQ (3r
On gal Manufacturer ({vntjt$
• 24-access riser(a)and accessible from surface?- - 0 0
• a
El ❑
Alarm or Control Panel Installed?- -
2 Control Panel equipped with Timer I ETA 1 Counter- - 0 E ❑
- Pump Installed in ❑ Bucket or dal Block or 0 Other a �/
Pump Make/Model Zo/l?u/ ld I S Z L- Floats or 0 Transducer
la
a Tank draw docent / 2- _In/min Pump capacity (» gpm Squirt Height 2 ft
Pump on time y3d.frc Pump off time I[ Daily flow set at ZCd gpd
we.d mmn
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 SEE ATTACHED
placement
Location of
buildings
El Observation ports&
clean-out locations
❑ Location of wells,
surface water.&
roads
El Undisturbed native
soil between
trenches
North Arrow
If the designer or installer feel the need for additional information/comments,it may be attached.
No. Pages Attached
Record drawing may also be on a seperate page 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 and Mason
aso Countyouty Codes Health and meet all
and Mason County Codes.
I further certify that all information contained on this I further certify that all information contained on this
form and attache• Reco • r accurate. form and attached Record Drawing is accurate.
/ 11/1/23
Sign reo In" Date
MIKE FARRELL / 11/1/23
YVh
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH tr .
The undersigned approves this Installation Report and
f '
Record Drawing on behalf of Mason County Public y I�
Health: 13 f 7 - e
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 rev sec 1,22/2014
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