HomeMy WebLinkAboutSWG2011-00047 - SWG As-Built - 10/12/2011 (2) r
RECORD DRAWING (ASBUILT) _ - r L
4 ri4;:X 3i, ii:a3F" } 1 - "
sal. 27/j - t?QG�/7 Assessor's Parcel# ��//J?— �3 - 4'043 ?
Permit Number
Applicant's Name 1 7 / f Lti b. /"--tr Subdivision
(NameJDiivis ion/B1ock/Lot)
Applicant Address
a-/a-D 2• 21 — Installer's Name rjVi J '/R s'ci< t/.4-t-tNG
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Z 2tcr►t.57t. 'rvr A- Des a,er's Name _. ;:
Ci State, T �_• r z:...0.- - _1*•••: ., . ._x:..
f �•" �3'�"s `s ., ,r,L. L. ;�.,�.�__'r .raj-. la.�� •�/�+' _.._._ ._.
} � �• a; - '" 'f —. Prior to Completion
_ �.-.. . N/A Yes
I. SEPTIC TANK ❑
>5 ft. From foundation? .................._-•-.""' ❑ gr
>50 ft from wells? . _ 0 V' ❑
>50 ft surface water? ...................................................._..... .. ❑ 0
Building stubout to septic tank: cleanout if not 1-2%? 0
ta Baffles intact and clean?................................................_......... ❑ 'lam El
Dividing wall intact?.................................... _............_ ❑ $
Risers installed for access?................................................_..... ❑ .l$ 0
tailed?(circle one) •••-••- 0 0
Screen baske "—'
Tank size: I - gal.; Manufacture: left-T i,�,j-LA t i
II. D-BOX ❑
Leveled with water? 00 -Er.0 0
Speed leveler used?
IIL DRAU FIELD ❑
>10 ft from foundation? "' ❑ 2r 0
>5 ft from property lines and easement lines? 0
> 100 ft from wells? �.- ❑
> 100 ft from surface water?
>10 ft from potable water lines? 0
Laterals level to±1 inch&end caps present if not looped? 0
Gravelless chambers utilized? 0 0 0
Gravel clean, properly sized,and proper depth?
PRESSURE SYSTEMS . ❑ ❑
Sand quality ASTM C-33? •._..................._
1 0
Head height uniform >24 inches? Actual hc:• height ,Q'� 0
Clean-outs and observation ports present? „Cr ill
Mound: Side Slope 3:1? ' 'O 0 ❑
Owner informed electrical connections must •e made by - 0 to
or licensed electrician and inspected :y L&I? w ��.
IV. PUMP/PUMP CHAMBER 0 0
Pump make ; Pump model -a
Chamber size gal;
Manufa s ...ge- 0 0
Height of pump off bottom of pun'', c,: •, -• inches
Pump chamber draw-down 1_ :allons p-, inch per minute
x ions per minute •
Pump capacity � ❑
Pump controls:Timer,Elapsed Time Meter, • • •ter? (Circle all that ..2 0
apply). If timer: Pump On .. p Off
' ' access?. 0
1 prinked . I: ,: s,on..Couf 1...D.m.s........................ s=-' -❑ ❑
Printed from Mason County D
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i .'S`.'—_'- , is _ C, a C',:
CHECKLIST
1 Drainfield&
manifold orientation •
& layout
C$- Trench/bed
dimensions and
critical distances
within layout
E Septic/pump tank
Iplacement 1
l�- Location of
buildings
0 Observation port&
clean-out location
ca Location of wells& (Q .X 4 L',' 3 ev 7t-1 Pg
roads
C9a-vtv..rt-t F (o.1) D F
• a Undisturbed native 13
soil between ° '
trenches
t2f7 North arrow
L9 d 0 .
J
ie o o
-, _
12-terF-d 0 4--,-.-C.:.T_.
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7
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CERTIFICATION OF INSTALLATION
Installer: Check a box from Row"A"and `B", sign and d to a certification
A. 0 I certify that I installed the system without any I certify that all deviations from the design stamped
deviation from the design stamped"APPROVED"by ( `APPROVED"by MCPH are shown above.
MCPH
B. I certify that I contacted the designer and left the 0 I did not contact the designer prior to final cover because the
system open for inspection up to 48 hrs prior to cover. designer waived the notification requirement.
I further certify that all information contained on this form is accurate. I understand that if the information contained herein is not
accurate,there will be just cause for immediate suspension of my installer certification,/1 �aG��_- ,
,0_,0_,,
S ture of Installer Date
The undersigned approves this installatio on behalf of ty Public Health.
Printed From Mason C�ountyas
Printed from Masan County DMS /042/i/