HomeMy WebLinkAboutSWG2022-00497 - SWG As-Built - 1/23/2024 "l
.RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number swG 2022-00497 Assessor Parcel # 3 1 904-1 1-900 1 0
Applicant Name Hess Daniel & Sara Subdivision (Name/Div/Block/Lot)
Applicant Address 18623 Elderberry ST SW
City, State, Zip Rochester WA 98579 Installer Name EnviroTech
Site Address 100 Sister Meadow LN SE Designer Name Jim Hunter & Associates
INSTALLATION CHECKLIST
WI Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type Pressure Trenches Pretreatment Type
>5 ft. from foundation? - fr;
-- El N/A YES El NO
>50 ft. from wells? - El ® 0
Z• >50 ft. from surface water? -
/.. J ❑ WI ❑
• Cleanout between building and tank? - .- - - -t —- ❑ lil El
U Tank baffles present? - - 0 III ❑
d 24"access risers over each compartment?- _.�+.`�f-- ❑ LE 0
,I W Effluent filter installed?- - ❑ III IDu) 1200 HB Precast
Septic tank size gal Manufacturer
_0 D-box water level and speed levelers used? - - ® N/A El YES 0 NO
p0 Manifold/D-box accessible from surface?- - ❑ ® ❑
u.
il OQCheck valves installed? - - El ❑
2 Transport Line Size 2inch Schedule/Class schellule 40
Bedrooms installed (check one) El 2 ❑3 1E 4 ❑ 5 ❑6
>10 ft. from foundation?- •- ❑ N/A YES 0 NO
0 >100 ft. from wells?- - ❑ ElW >100 ft. from surface water? - El
LL >10 ft. from potable water lines?- - ❑ I!7 0
Z > 5 ft. from property lines and easements?- - 0 2 0
Q
cc > 30 ft.from downgradient curtain/foundation drains? - - ❑ Iii ❑
Drainfield level and observation ports present - - ❑ ® ❑
® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 Eil ❑
11 Pump tank setbacks consistant with septic tank? - - ❑ N/A ® YES 0 NO
Pump tank size 1200 gal Manufacturer H B Precast
Q24"access riser(s)and accessible from surface?- - El lJ ❑
I-
a. Alarm or Control Panel Installed? - - 0 ® ❑
2 Control Panel equipped with Timer/ETM/Counter- - ❑ Z ❑
n
EL Pump installed in ❑ Bucket or E On Block or ❑ Other
a• Pump Make/Model Zoeller N-153 ® Floats or ❑ Transducer
m 4in 88 25in
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time 55sec Pump off time 4hrs Daily flow set at 88 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
El Location of /s: 41=' G
buildings
• Observation ports&
clean-out locations
❑ Location of wells,
surface water,&
roads
El Undisturbed native
soil between
trenches
El 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. State and Mason County Codes
I further certify that all information contained on this l further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
21-2 3
Signature of Installer Date
,1 t1C //LwrJ F i
Printed Name of Signee MASON COUNTY PUBLIC HEALTH -� i�
M Z F <
The undersigned approves this Installation Report and �' StU'=r;
s.
r O LAMES R.HUNTER
Record Drawing on behalf of Mason County Public ilcFrisfn DEStGNFR
Health:
A
���mohnh.
NSTIAl (-2_3 ta,� EXPff!ES: U3/22/L
Signature o nvironmental 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 1/22/2014
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