HomeMy WebLinkAboutSWG2022-00075 - SWG As-Built - 3/22/2024 •
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RECORD D :
i DRAWING ((AS�LT) pg. 1 '' :`;
\
, : MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number sw0 1 dZ 2 (2
Assessor Parcel# 3Z02 55—b etsv YR
Applicant Name Ka r ) 14dcury 5 Subdivision (Name/Div/Block/Lot)
Applicant Address (,A 2,o k r `der r�
City,State, Zip S k/4 cLc44 g L/ Installer Name 112r A iiki,,/6Ne I
Site Address ('2a Sc c"-Agle YZ.� Designer Name 'S•, u/kti-er
INSTALLATION CHECKLIST
1 El Full System Installation 0 Tank(s)Only 0 Drainfield Onl- •r
y 0 Repair 0 Other
;1 System Type l.t`P _ Pretreatment Type
>5 ft from foundation? - -
❑ NIA [l YES 0NO
>50 ft from wells? - -
El El
Z >50 ft from surface water? - - ❑ KI ❑
F4- Cleanout between building and tank? - - 0 El
�• y Tank baffles present? - - 0 3 0
d24'access risers over each compartment?- - 0 N El
rW Effluent fitter Installed?- ® ❑
Septic tank size /2 C)O gal Manufacturer____-{e,Us,Q - 1-.�
1. 9 D-box water level and speed levelers used? - - ❑ NIA ❑ rsa
°'' C3 Manifold/D box accessible from surface?- [ NO
E:l El ID
.:.. as Cif"
•,:.: ,E Check valves installed? - El ❑
i•,,•
Transport Line Size 2Schedule/Class cc q.
%" (check Bedrooms installed
one) 2 3 ❑4 ❑ 5 El 0 CommercialfOther
.`,- >10 ft from foundation?- - ❑ NIAVI g
0 NO
i... >100 ft.from wells?- - ❑ �,
. ,
- i >100 ft from surface water? - - El ,1! El'
•
'j u >10 ft.from potable water lines? - El111 Dia
El
"-• > 5 ft.from property lines and easements?- n
tip,;,:.,
ik, > > 30 ft.from dovmgradient curtain/foundation drains?
vs: Drainfield level and observation pts present- 0
t;''..-• 0 Graveless chambers or Clean gravel used? (check one)
.iwis-(; Proper cover installed over dreiniield?- ❑ ,-/
wi Li.
e;�l Pump tank setbacks consistent with septic tank?- �/YE3 0 NO
.4. ❑ N/A t3Q
lift, Pump tank size /WO gal Manufacturer Hoe-'3 e. %rsi 5
• I.--
24'access r ser(s)and accessible from surface?- - El 131, 0
Lig
;.;. 0. Alarm or Control Panel Installed?- - 0 ❑
_ IF D
; Control Panel equipped with Timer 1 ETM rCounter 0
•`(i. a. Pump Installed in ❑ Bucket or 'On Block or ❑ Other
Pump Make/Model Qr4 ca sZ Moats or
❑Transducer
%; a Tank draw down 2- In/min Pump capacity L 9 gpm Squirt Height Z 9 ft
•
.`. Pump on time^1 110 Pump off time it4),(f Daily flow set at 6e pd
,,�, t e.eee,,rrnu+n
e.V MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# 3 zv Z'S S e 6`14e .
RECORD DRAWING
❑ Drainiteid A manifold
orlanlation&layout
j wldlmertetons for
/ ra-location.
.0' ❑ Trench/bad
dimensions and
criticAl distances
tg within layout
0 Sump tank l f�
placement ,c,
❑ Location of b tge l� V'�
aids-trig/proposed
❑ Observation ports,
dean-out locations,
&manttddsrd-boxes
❑ Location a(welts,
surface water,roads.
&waterlines.
❑ Reserve area(e)
❑ North Arrow
N the designer or installer feel the need for additional information/comments,it may be attached.
Record drawing may also be on a seperato page attached. No.Pages Attached
CERTIFICATION OF INSTALLATION
,
INSTAJ I FR 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"APPROVD°by
County Public Health end 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 end meet all State myself and Mason County Public Health and meet all e
and Mason County Codes. State and Mason County Codes
I further certify that all Information contained on this 1 further certify that all information contained on this i
form and attached Record Drawing Is scour e. form and attached Record 1) : •g accu;te/ %
lf fifii‘,i
S stun of stellar Date 1 �i t
LJ,C� .e1 f irre it ,�I 3_ cz- 2_. s
Printed Name of Signed •. - w r�▪ I •
MASON COUNTY PUBLIC HEALTH .i sib . .1"' Z L• �f`
The undersigned approves this Installation Report and \N%i 5101)273 id.,
Record Drawing on behalf of Mason County Public 0, JAMES It.HUNTER ''' .
tICF.NSFt)DESiGNEit •
Health: .• '46't`s'x ' Is 1 .1641b `
li --dM EXIMES: 03/22/ 2.....(e t
Signature of Environ nta!Health Specialist Date (designer's stamp, signature end date) f
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY iad WEB SrrE up° 121112°16 ;E
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