HomeMy WebLinkAboutSWG2005-00565 - SWG As-Built - 9/25/2008 RECORD DRAWING (ASBUILT) Mason County Public Health
PARCEL IDENTIFICATION
oo`��`� Assessor's Parcel# 12108- 50 -01019
Permit Number SWG o�00 -- (Twelve-Digit Number)
Applicant's Name SUE DAVIS Subdivision
pp (Name/Division/Block/Lot)
Applicant Address 1770 NW 60TH Installer's Name ROBERT H PAYSSE •
City,State,Zip $EATTLE, WA 98107 Designer's Name SAME/PIONEER DIGGING
INSTALLER CHECKLIST
N/A Yes Prior to Completion
I. SEPTIC TANK
>5 ft. From foundation?................................................_.......... ❑ 1st ❑
>50 ft from wells? ......................................................_........._ ❑ 14 ❑
>50 ft surface water? .................................................. -.......... ❑ X ❑
Building stubout to septic tank:cleanout if not 1-2%? 0 1I 0
Baffles intact and clean?..............................................._......... ❑ 1:4 0
Dividing wall intact?.................................................-. 0 1R 0
Risers installed for access?........................................................ ❑ litt0
Screen basket or effluent filter installed?(circle one) ..............._._ 0 till0
Tank size: 1200 gal.; Manufacture:FRED HILL MATERIALS
IL D-BOX
Leveled with water? A 14 ❑
Speed leveler used? Vi j>i.Q 0
III. DRAINFIELD
>10 ft from foundation? 0 1MI 0
>5 ft from property lines and easement lines? 0 1R ❑
> 100 ft from wells? 0 Tilt 0
> 100 ft from surface water? 0 lit 0
>10 ft from potable water lines? 0 181 0
Laterals level to+1 inch&end caps present if not looped? 0 1 0
Gravelless chambers utilized? X. 0 ❑
Gravel clean,properly sized,and proper depth? 0 111 0
PRESSURE SYSTEMS
Sand quality ASTM C-33?......................_.............._..._.... ❑ lat 0
Head height uniform >24 inches? Actual head height 1I ❑ ❑
Clean-outs and observation ports present9 0 114 ❑
Mound: Side Slope 3:l? ❑ 14 o
Owner informed electrical connections must be made by
owner or licensed electrician and inspected by L&I?............. ❑ VI 0
IV. PUMP/PUMP CHAMBER
Pump make HYDROMATIC ; Pump model HE8 ❑ 11 0
t Charn*lize 1000 gal; Manufacture FRED HILL MATER. ❑ 1:21 ❑
Height of pielop off bottom of pump chamber inches
Pump chamber ow-down gallons per inch per minute
Pump capacity ,` gallons per minute
Pump controls:Tyr,Elapsed Time Meter,Counter?(Circle all ❑ 1sl ❑
that apply). If tintimillr Pump On Pump
Off
Riser installed far dccess?...................................................... ❑ lit 0
Alarm install .........................................................._......_ ❑ 151 0
RECORD DRAWING
CHECKLIST
❑ Drainfield&
manifold orientation
& layout
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
placement
❑ Location of
buildings
❑ Observation port&
clean-out location
❑ Location of wells&
roads
❑ Undisturbed native
soil between INSTALLATION
trenches
❑ North arrow WAS
AS PER DESIGN
CAUTION::Minor adjustments to septic tank location and drainfield orientation made in the field by the installer are generally acceptable
to both the department and the designer but could in certain cases compromise the viability ofthe system. It.is the installer's responsibility
to obtain prior written approval from either the health department or the designer before making any deviations from the design that affect
the system viability. Any deviations from the approved design must be shown above.
CERTIFICATION OF INSTALLATION
Installer: Check a box from Row"A"and"B", sign and date the certification
A. 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. 0 I certify that I contacted the designer and left the X 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 requiren�
I further certify that all information contained on this form is accurate. I understand th . ' formation d herein is not
accurate,there will be just cause for immediate suspension of my installer certificati .
Si of 4001 a Date
"np:
The undersigned approves this installation on behalf of Mason County Public Health.
Enviro ental HSpecialist Date
Revised January 2008