HomeMy WebLinkAboutSWG2022-00312 - SWG As-Built - 10/27/2023 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION T`r`,,'Gz""tn':",
Permit Number SWG tC tt- al,31i Assessor Parcel# y7 1 2 3 33 00000
Applicant Name Tor -1,11,+n.CD ' Subdivision(Neme/Div/Block/Lot)
Applicant Address rod t kkokrd City, State, Zip S LC/Io.r/WA '1 O.p
-SPI Installer Name I rcun5 I/i ll(n 1/41
Site Address Zco E M mac Ne,ha.s Oi Designer Name A Jar, // .t1<.--
.c. INSTALLATION CHECKLIST '.:. s'
Et Full System Installation /0 Septic Tank Only 0 Drainfield Only 0 Repair
System Type .(ram 4 i...-4 AO Pretreatment Type
•' •' >5 ft.from foundation? 0 N/A 123 YES 0 NO
+`" >50 ft.from wells? - ❑ N ID
1,>50 ft.from surface water? - 0 ® 0
Cleanout between building and tank? 0 El ❑
-tic Tank baffles present? - 0 CZ 0
_ 24'.access risers over each compartment?-
iiEffluent filter installed? ❑ IZI ❑
-,Septic tank size IC 30 gal Manufacturer Tn f.Itryls--
D-box water level and speed levelers used? ®WA 0 YES ❑ NO
Manifold/D-box accessible from surface?- ® 0 0
`'Check valves installed? ID ❑ VI
Transport Line Size 2 Schedule/Class '10
;, Bedrooms installed(check one) ❑ 2 ❑3 ❑4 r21 5 ❑6
'>10 ft.from foundation? ❑ WA YES 0 NO
>100 ft.from wells?- 0 0
',I >100>100 ft.from surface water?- 0 IFT 0
• >10 ft.from potable water lines?- - ❑ af 0
>5 ft.from property lines and easements? 0 �j 0
h.>30 ft.from downgradient curtainttoundation drains?- - 0 LT!i 0
_4 Drainfield level and observation ports present - 0 ® 0
❑ Graveless chambers or a Clean gravel used? (check one)
Proper cover installed over drainfield?- 0 lg. 0
• y'Pump tank setbacks consistent with septic tank? 0 WA Q vas 0 NO
2.:St{:Pump tank size I gal Manufacturer Se,f) I I•a.bi-
'. ::.;24'access riser(')and accessible from surface?- 0 ® ❑
I,I.1 Alarm or Control Panel Installed? - 0 ® 0
-'S .'Control Panel equipped with Timer/ETM/Counter- - 0 IN ❑
• ;Pump installed in ❑ Bucket or On Block or ❑ Other
Pump Make/Model L.\S.cil tQI! R!Floats or 0 Transducer
Tank draw down i 3/y l in/min Pump capacity y.S gpm Squirt Height Srir
'`t)Pump on time I. t7I7 ,part Pump off time c/:00 bw 3 Daily flow set at clSJ gpm
m:.w+zaw.
RECORD DRAWING (ASBUILT)pg. 2 MASON COUNTY PUBLIC HEALTH
' RECORD'DRAWINO 171
[Reinhold&
manifold orientation
&layout
El Trench/bed
dIIMnelana and
algal dooms
within layout
• SaptlrlWmp lank .l,C�
gacement FC C�
❑ Location of
bulldog. /.
❑ Observation ports&
duM1ON locator's
• Location dwell.
swim*water.&
roads
❑ Undiluted native
eoti between
benches
• North Anow
If the designer or installer feel the need for additional infonnatioNoommenta,it may be attached.
Record drawing may also be one uperate page attached. No.Pages Attached I'
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
I certify that I installed the system in accordance with I certify that the system has been installed in actor-
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
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 wing is accurate.
Signature annotator Date t
II I VI'SA1'71
ors Ih k�
Printed Name of Sigma .. .•. -. 4�'{,..
MASON COUNTY PUBLIC HEALTH y/ '
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public LA711 le
Heath: ��
Vow ' vW cfill
Signature of Environmerbi Health Specialist Date (designers stamp, signature and date)
THIS FORM MAY BE SCANNED ANOAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
revised 1a2/I014
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