HomeMy WebLinkAboutSWG2021-00658 - SWG As-Built - 12/1/2023 I l
fECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG ;-Oo-� - Ofp O Assessor Parcel # 'C7,7,'09 7'ys.%_0
Applicant Name 1\rot}'\ va1(I�h\1viS Subdivision (Name/Div/Block/Lot)
Applicant Address Vj(;\ cIic, H t i pa_
-
City, State, Zip cS\V Lk1)11 \��1 t--I C\�� L-1 Installer Name ^.(0Iil ('�'^" '`
Site Address SNti\,. Designer Name vV\ -40(-Vire,NC
INSTALLATION CHECKLIST
Lys Full System Installation ❑ Tank(s)t Only ❑ Drainfield Only ❑ Repair El Other
T\System Type ? t e%7V� \S1 d Pretreatment Type
>5 ft. from foundation? - - ❑ NIA BYES ❑ NO
>50 ft. from wells? - - - ❑ E+ , ❑
Z >50 ft. from surface water? - - ❑ [1 ❑
< Cleanout between building and tank? - - �} ❑ [ ❑
U Tank baffles present? - NOV 1 L1�2 U„ . ❑ ,_,f ❑
f- 24" access risers over each compartment? - 1 - ❑ ❑
a.W Effluent filter installed?- ❑ ❑
N
Septic tank size \1-CO gal Manufacturer 1.,‘ G-. \Vt. -4-a r'
0 D-box water level and speed levelers used? - - �/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- - [f ❑ ❑
co, u.
Z Check valves installed? - - ❑ ❑
OQ
2 Transport Line Size Schhee ule/Class
Bedrooms installed (check one) 2 El 3 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A [ YES ❑ NO
O >100 ft. from wells? - - El ❑
W >100 ft. from surface water? - - ElEll% >10 ft. from potable water lines?- El ❑
—z > 5 ft. from property lines and easements?- - ❑ ❑
Q
Wo
> 30 ft. from downgradient curtain/foundation drains? - - LI 12(, ElDr infield level and observation ports present - - El DE ❑
[.7 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ El/ ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A BYES ❑ NO
Y Pump tank size OP, 12 CO gal Manufacturer T s \-. \\rr✓ c
< 24" access riser(s) and accessible from surface?- - ❑ ,._/ ❑
a Alarm or Control Panel Installed? - - - ❑ LJ El2 Control Panel equipped with Timer/ ET Counter- - ElE ❑
m
a Pump installed in ❑ Bucket or On Block or ❑ Other
a Pump Make/Model t \t..,y o S IMF -7 c) E Floats or ❑ Transducer
a
Tank draw down -' in/min Pump capacity 6(4 gpm Squirt Height (n Z-- ft
Pump on time 5 1 5 c c Pump off time L \, --- Daily flow set aty 0 gpd
Updated 12/7/2015
r!JICPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# S -U v (I-7 SUO l 1-0
RECORD DRAWING
❑ Drainfield&manifold
orientation&layout
w/dimensions for
re-location
❑ Trench/bed
dimensions and
critical distances tcj r
within layout /���A--C
r—)
5
❑ Septic/pump tank ,-,
placement
❑ Location of buildings
existing/proposed
❑ Observation ports,
clean-out locations,
&manifolds/d-boxes
❑ Location of wells,
surface water, roads
&waterlines
❑ Reserve area(s)
•
❑ North Arrow C` `\` 1 '4 t^ s(e'Lr `( eet) t b., \ct- Q ,Cti 0 I- 1✓`s_p-
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. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form and ttache cord Drawing is accurate. form and attached Record Dr. in. is accurat:
l lz f� � 0410.41. .
Sr ature of Installer Date 1
-1cb j v' k ' ~ or,. tall
Printed Name of Signee . 0*430't ?'E//
MASON COUNTY PUBLIC HEALTH .S' �sl l
The undersigned approves this Installation Report and 4tzz�. stool :4,,,,� LAMES R.iiUPlfEft �1
Record Drawing on behalf of Mason County PublicLICENSED DEStC,NER !
`-.). 3 vr���v>t,
\C.cl- cLtiry\AC* VA \7)-2).Health: EXPA!ES: 03/22/
Signature of Environmental Health Specialist Date (designer's stamp, signature and date)
4 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated"—';rzoi',
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