HomeMy WebLinkAboutSWG2021-00512 - SWG As-Built - 10/13/2023 I
---_---„
-RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH !t
I iawl PARCEL IDENTIFICATION
Permit Number SWG eb21 -!rT/Z_ Assessor Parcel#ZZZZ-4-1-5-)-Q'„ooS
Applicant Name Nell let LC L Subdivision(NamelDly/elock/Lot)
Applicant Address /0O 3(c VA(All 44,0 MO
CO.state,Zip . _,1 Trip 64.14 90/77 Installer Name NtF LLG
Site Address //v 6 0171Agfr.l/iP✓1> Designer Name C- td1 £ hi
INSTALLATION CHECKLIST
I gut System Wtelaeon 0 Tank/s�)Only .r�0 DmIn ski ndy ❑Repair 0 Other
J System Type NU (NAW 6 -ADO Pretreatment Type Qiro- c_
{Il��/ >5 R from wells foundation? - - ❑N/A �dl yse 0 No
>50 R from wells? - - ❑ /�' ❑
ZY >5011.from surface wateR - - ❑ El 0
F. Cleanout between building and tank? - - ❑ lc 0
() Tank baffles present? - - ❑ El
E24'access risers over each compartment?- ❑ 0
WN Effluent fitter Installed?. -Dug,SOV ❑ Pi
Septic tank the '000 gal Manufacturer er el-wi,. ccq,S 1
f
�9 Dbox Water level and speed levelers used? - - ®WA yea ❑ NO
tr.: 00 ManIfokJU-box accessible from surface?- - ❑ ❑ ,
Y'r Ri Check valves installed? - - ❑ ® ❑
•:, d n
f § Transport Line Size . Z Schedule/Class YC
q"£
Bedrooms installed(check one) El ®3 ❑4 0 5 ❑a ❑CommerdallONer I 1
>lO R from foundation?• - ❑ WA YES ❑ No
^ >100 it from wells?• - ❑ 0
'+i. u-j7 >100R from surface wateR- - ❑Z ��yy}}��,, El
OS; LT. >10 a.from potable water lines?- - ❑ ^Bj, 0
" >5 ft.from property lines and easements?- . ❑ F&&,,IiTT 0
a • d >30 ft.from downgradlent curtalnlfoundatlon drains?• - ❑ 0
O Draingeld level and observation ports present• - ❑ El
t..: og Graveiess chambers or 0 Clean gravel used? (check one)
A , budg
ed over dreineeld?- - ❑ ❑
.w Pump lank setbacks consistent with septic tank?- • /❑ WA 1p YES 0 NO
Y Pump tank sin /Z 00 gal Manufacturer ihs r tat rrrrkc7 p
2c aooaes dser(s)and accessible from surface?. - ❑ ❑
li ~ Aiann or Control Panel Installed?- - ❑
6 ❑ Et ❑
f control Penh equipped with Timer I E(M/Counter-
z
fL Pump InslaAed In 0 Bucket or n Block or 0 Other
PlmpMakeimod�eff - BNi ,o Floats or ID Transducer
y Tank draw down Z. INmIn Pump capacity Z qpm Squid Height 3 fl
Pump on time IY5 Pump off time Y Dairy now set at 2 jag_gpd
WAN'SI nno,r
., . ... . . ---. _
I _
Mason County OSS Installation Report pg. 2 Parcel a 22223-51-06008
ABANDONMENT RECORD
Were existing septic components abandoned as pan of this project? -
❑ YES 0 No
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300?
0 Yeg 0No
RECORD DRAWING
This
I.a eneeet meted and most be e[wu{und aaecopM..neuan b.nbed.m rh.nye W n.munint..elms..end mere dent. me Typal FFae
Owns anti.. Droning a man'bb p,bnblmn 5 leycul.sepuuuLnI Irmo laelwn.Not aibw,merve drsmfls d.emmng and proposed belly[rot ayn I.era..aYrS*
pelt opservalgra pvb.tlaewp.and inner mSmlanann emu punts. mwnylere Remo Pawns may malt eaalonal delays n nnalinwl.wn aayiey And rum warn
0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
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 Stale myself and Mason County Public Health and meet al/
and Mason County Codes. Stale and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
f !off and attach-• -a ord ing I :• wale. form and attached Record Drawing is accuratearea
re_ // 4 2
•�ns(alle e•le
43 A
Printed Name of Signed `? Ai m
a ' dV
MASON COUNTY PUBLIC HEALTH hW � £e � A a
The undersigned approves this Installation Report and S 4.L ceesEp oe All in
Record Drawing on behalf of Mason County Public 1
l•'•ns us,la
Health'
WI(511/3
Srgnalwe of Environment Heath,Speciansl Date Stamp. signa(ure and date)
--
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE prone,ecl:'"
p J µ.q
`_
�. Q3 I�rill �lr,i u' f
x 1�, I.
�L k Ier 1 „ . I 1 ��m1
I 4 1 I l I I I
% 1 Ja�- I N 1 r 1 n
o 0. c, 41 x J 4 [1:4.
IU1
O1 I li r.
1 �N`
A
ISI
di
I
Ct
/1\ 1-..\Ft " tilij
fi
i
J
I Q u
re
y APP i I ROVE ,
Ilb a'i""' Vichl
OCT 13 2023 r ' B
J:cf4'Cn.gn c'r r.. ti4i ;; RI �E I�
Ate*
1 74-2-S 5I-Orocet
t
5-6„.G-70-7l -Ou5 /z. I -Z0
222 23 3/. °Ludy