HomeMy WebLinkAboutSWG2023-00375 - SWG As-Built - 10/18/2023 • SEC , ?0Z 1
RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG Z3 e.-. -303 7 S Assessor Parcel# ZZ J 0 ` 5 OOOOj j
Applicant Name --S„\I -\'\ re,J{: Subdivision (Name/Div/Block/Lot)
Applicant Address 1131`f N W 114 CI .
City, State, Zip Va,O1Aic- lniA 9tToa5 Installer Name /frav;s Vi(I1nc.s
Site Address S213 F P%d 1- et. PA Designer Name A do,., // 1-ci—
INSTALLATION CHECKLIST .
b Full System Installation ❑ Septic Tank Only 0 Drainfield Only ❑ Repair
System Type OSC-AR )(De-- Pretreatment Type
>5 ft.from foundation? - - ❑ N/A 3 YES ❑ NO
>50ft.fromwells? i ECRII V [` ' 0 ® ❑
• >50 ft.from surface water? - ❑ Z 0
Z
Q. �I Cleanout between building and tank? -- c
0.?Tank baffles present? - - 0 ® ❑
a24 access risers over each compartment?By; - ❑ ® 0
W Effluent filter installed?- - 0 11 ❑ E
Septic tank size f 0 St) gal Manufacturer ,��,id I6/4.ce-neei1-
O .
D-box water level and speed levelers used? - - El N/A 0 YES 0 NO
0O Manifold/D-box accessible from surface?- - n 0 0
c9E Check valves installed? - - E] 0 0
CQ 0i
Transport Line Size 1 Schedule/Class SClie-rLk- Yo
Bedrooms installed(check one) n 2 0 3 ❑4 ❑ 5 ❑6
>10 ft. from foundation?- - ❑ N/A 21 YES ❑ NO
O >100 ft.from wells?- - ❑ ❑
W >100 ft.from surface water?- - ❑ El 0
li >10 ft.from potable water lines?- - 0 IXT 0
• Z >5 ft. from property lines and easements?- - El El
d >30 ft.from downgradient curtain/foundation drains?- - 0 IN 0
0 Drainfield level and observation ports present - - 0 N 0
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ El 0
Pump tank setbacks consistant with septic tank?- - ❑ NIA ® YES ❑ NO
• Pump tank size /9 v gal Manufacturer �ti-16/ Pllc<>►cn 4-
Z„
< ..24"access riser(s)and accessible from surface?- - ❑ N 0
a.1Alarm or Control Panel Installed? - - ❑ ill 0
2`:Control Panel equipped with Timer/ETM/Counter- - 0 ❑
a. Pump installed in ❑ Bucket f1or On Block or ❑ Other
. Ell' Pump Make/Model Lowed -C' / LOT D ,® Floats or 0 Transducer
• R. Tank draw down Qc: O'-' in/min Pump capacity 30 gpm Squirt Height ft
Pump on time P'-' D?v,. c Pump off time '/ £c✓ Daily flow set at qpm
wised 1/22/2014
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING 'c
Drainfield&
manifold orientation
&layout
▪ Trench/bed
dimensions and
critical distances
within layout
• Septic/pump tank
placement
Location of
buildings
Observation ports&
clean-out locations
▪ Location of wells,
surface water,&
roads
0 Undisturbed native
soil between
trenches
• 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 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.
1/2.9/7-3
I further certify that all information contained on this
State and Mason County Codes
I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record D wing is accurate.
Signature of Installer Date
�IIeut.5 N:
Printed Name of Signee ^'t :•• i.
MASON COUNTY PUBLIC HEALTH •
5lou j `{
The undersigned approves this Installation Report and ��: 1..H •
g PP P O.. ADAh1J.ltillNTEft
Record Drawing on behalf of Mason County Public
Health: ,A 11.4:
\6"1. ("OM (7f(a(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
revised 12212014
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