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HomeMy WebLinkAboutSWG2021-00356 - SWG As-Built - 2/8/2024 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG f;.QP--\ V (003 5E�7 Assessor Parcel # . _/(js--]C_ 93/ 33, Applicant Name ,�j Lt v-✓41 'C , SC°z7_ Subdivision (Name/Div/Block/Lot) Applicant Address /6OC 7 ./(p ( . (-61-d— SP (-3“-, ,4F-Y- -3 Ig City, State, Zip 0 Ai C'k LA;c<, 9 5z— Installer Name flu ici se , c;; `-- SiteAddress -5Gtt,.l e Designer Name ,4/c0 T,A' jci INSTALLATION CHECKLIST ❑ Full System Installation ank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type c'a'. 4-/ Pretreatment Type >5 ft. from foundation? - - ❑ N/A YES ❑ NO >50 ft. from wells? - - ❑ Lr ❑ >50 ft. from surface water? - ❑ CIZ �-,/ H Cleanout between building and tank? - - ❑ La ❑ U Tank baffles present? - - ❑ Er ❑ a 24"access risers over each compartment?- - CIE� ❑ W Effluent filter installed?- - ❑ ❑ u) Septic tank size ( JCJ gal Manufacturer 4o r W ty .e-.) 9 D-box water level and speed levelers used? - - ❑ N/A 2- ❑ NO oO Manifold/D-box accessible from surface?- - CI m 2 Check valves installed? - - ❑ ❑ ❑ O Q i, Transport Line Size Schedule/Class 14U Bedrooms installed (check one) ❑ 2 E S ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A rEs ❑ NO 0 >100 ft. from wells?- - CI CI W >100 ft. from surface water? - - CI ❑ li >10 ft. from potable water lines?- - ❑ L�i,"/ ❑ Z > 5 ft. from property lines and easements?- - Cll�E, ❑ a2 > 30 ft. from downgradient curtain/foundation drains?- - CI Et El Drainfield level and observation ports present - - ElI3 ❑ ❑ Graveless chambers orean gravel used? (check one) Proper cover installed over drainfield?- - ❑ I2l ❑ Pump tank setbacks consistant with septic tank?- - ❑ N/A ❑ YES ❑ NO • Pump tank size gal Manufacturer Q 24" access riser(s)and accessible from surface?- - ❑ ❑ ❑ 1-- Alarm or Control Panel Installed? - - ❑ ❑ ❑ n. 2 Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑ D CI- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other n' Pump Make/Model ❑ Floats or ❑ Transducer 2 a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 12/7/2015 • w MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# 2fCx -7C RECORD DRAWING ❑ Drainfield&manifold orientation&layout i+c;,l(f' w/dimensions for re-location. ❑ Trench/bed C'O dimensions and critical distances t within layout -7c ❑ Septic/pump tank V\(; placement ❑ Location of buildings existing/proposed I • ❑ Observation ports, clean-out locations, &manifolds/d-boxes ❑ Location of wells, ' tt surface water,roads. A _ w � &waterlines. /1/° ❑ Reserve area(s) I 90 ❑ North Arrow _ ( I v� Q — -t-F -r ?C) • 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 /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 attached Re o d Drawing is accurate. form and attached Record Drawing is accurate. l7— zg Signature of Installer Date 0f FLA v -e(d Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: CV) e%/9/-z-/ 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 Updated 12/7/2015 4 Mi SON COUNTY PUBLIC HEALTH AFTER THE FACT RECORD DRAWING ASBUILT " ♦s7 .'..r-:• ---. 74 .. - . e:an_`y-b.V,:-'., ?n 'g,yi'' �� •4 . ..,... k {kh4% 75.c�' Xc.?;n. K it 'i� `?:-y� �� r �' 4 .),�6lt�, .�`}t..n' -,�:.�. ` Owner's Name ``1t-A-t /ttir -t-r D1 3 LµAssessor's Parcel# - i 05—7(a — q0 133 welvc-Digit Number) Owner's Address $'1 i.) -k-lE4S7 * \N1 Site Address X?CX t 1: Rl ' -- ) 1 t)f.J OrJ City,State,Zip C_#S--`-( t t..1 C. 21 S 11 Designer's Name N0 c—C -kkAJ • .ra'--©OIZS 1. TYPE OF SYSTEM COL \1E-Or'a3 Pc L- C , JV 2. SEPTIC TANK No YES >5 ft. From foundation?.......................•••••••......••-••••••••-•••••••••• ❑ 0 /-)A >50 ft from wells? ................................................................... ❑ 0 >50 ft surface water? .............................. ............................ ❑ 0 Building stubout to septic tank: cleanout if not 1-2%? 0 0 Risers installed for access?............. ❑ 0 Tank size: gal. 3. DRAINFIELD >10 ft from foundation? 0 gt >5 ft from property lines and easement lines? 0 It > 100 ft from wells? 0 0 /J A > 100 ft from surface water? 0 0 ti4 >10 ft from potable water lines? 0 . 0 /A Clean-outs and observation ports resent9 0 kr 4. PUMP/PUMP CHAMBER _ ❑ This attached record drawing was created by Mason County Public Health using information obtained from available records and a site inspection. All locations are approximate. ►J o-rr : S�-(5 ‘.)Se-e. ii`-( s)*•)7 -( A„ Lc c) ,_,_ g,, 1 Lk\1 L.P (>f4vR-) A r -r1 of I N Yt-v u. A Sv i' .: Environmental Health Specialist Date or t".P,y fy5' Gi2--tA-i- . T ---tom-C- FAt--r- 12-- -5 t.r,cie- rF AsF›,..)‘{--r- \N P.4-LE, k t, 2011 F,,f ... ,sse A.)\c_ct.AtJAy.Ao Revised May 2013\ PAGE: . OF Printed From Mason County DMS Printed from Mason County DMS Ilk 1 ?PEA? A- 1t, c 3 A • 161) 2 t_ G� pSj poKT o rig7_C _ tk � This site map was created by MCPH by coordinating measurements and information from several sources,Including the Mason County GIS and a field review. All locations are approximate Record Drawing tOON..•, 1.j Parcel:32 t o5 —?(o 33 -� Owner: k T tR-‘4.-H Date: L-{ Le . rvrldng ,a safier • healthir Mason County Page: 2- of 2-, Pr nr�.e`c From Mason County DIMS Printed from Mason County DMS