HomeMy WebLinkAboutSWG2022-00591 - SWG As-Built - 12/5/2023 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2022-0059 I Assessor Parcel # 320215804019
Applicant Name CHARLES EDWARDS Subdivision (Name/Div/Block/Lot)
Applicant Address 3750 OLD GOLIAD RD SHORECREST 1ST ADD LOT 19
City, State, Zip GOLIAD, TX 77963 Installer Name OWNER
Site Address XX HILLCREST DR Designer Name ADAM HUNTER
INSTALLATION CHECKLIST
0 Full System Installation 0 Septic Tank Only ❑ Drainfield Only El Repair
System Type SIMPLE PRESSURE Pretreatment Type N/A
>5 ft. from foundation? - - ❑ N/A Q YES ❑ NO
>50 ft. from wells? - - ❑ 0 ❑
Z• >50 ft. from surface water? - - CI 0
• Cleanout between building and tank? - - 0 0 ❑
U Tank baffles present? - - ❑ 0 0
a24" access risers over each compartment?- - 0 0 CI
W Effluent filter installed?- 0 CI
N 1060 INFILTRATOR
Septic tank size gal Manufacturer
CI D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO
�O Manifold/D-box accessible from surface?- - CI CI
032 Check valves installed? - VALVE BOX HIGHER THAN D.F. - 0 ❑ ❑
pQ
2" H4
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑� 2 ❑ 3 0 4 ❑ 5 ❑6
>10 ft. from foundation?- - ❑ N/A 12 YES ❑ NO
0 >100 ft. from wells? - - 0 0 ❑
W >100 ft. from surface water? - - CI 0 CI
u., >10 ft. from potable water lines?- - El ✓❑ El
Z > 5 ft. from property lines and easements?- - CI 0
C > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑
0
Drainfield level and observation ports present - - ❑ 0 ❑
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑✓ ❑
Pump tank setbacks consistant with septic tank? - - 0 N/A J❑ YES ❑ NO
Pump tank size 1060 INFILTRATOR
gal Manufacturer
< 24" access riser(s) and accessible from surface?- - 0 0 ❑
H
a Alarm or Control Panel Installed? - - 0 0 0
2 Control Panel equipped with Timer/ ETM /Counter- - El 0 ❑
a Pump installed in ❑ Bucket or 0 On Block or ❑ Other
a• Pump Make/Model ZOELLER N152 0 Floats or ❑ Transducer
d Tank draw down 2 in/min Pump capacity 40 gpm Squirt Height 48 ft
Pump on time 1 MIN Pump off time 4 HRS Daily flow set at 240 gpm
revised 1/22./2014
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
placement
❑� Location of
buildings
❑� Observation ports&
clean-out locations SEE ATTACHED
El Location of wells, P P
PRO
surface water,&
roadsA E
❑� Undisturbed native DEC 0 6 20
soil between MASON COUNT YENVI
trenches �RwO,NMENTAL HEALTH
El North Arrow J,B•r
If the designer or installer feel the need for additional information/comments, it may be attached. 1
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. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form an att ed Record Drawing is accurate. form and attached Record Drawing is accurate.
10/30/23
Signature of Installer Date
CHARLES EDWARDS 111,Printed Name of Signee ''
10/30/23
,.
MASON COUNTY PUBLIC HEALTH ,t' • ...-
f,
The undersigned approves this Installation Report and ''':i,
.,,,-
Record Drawing on behalf of Mason County Public �I.
H alt : ikr• ''s!
` tikh .-�l/ —6 ✓23 0 .ADAMJ.HUNTER % Ta
Il t i(!F N$t,il tW 5T.Nf-.2...
Sig to of Environmental Health Specialist Date (designer's stamp, s?gilature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
revised 1r22/2014
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