HomeMy WebLinkAboutSWG2012-00185 - SWG As-Built - 3/22/2024 V
SEPTIC SYSTEM INSTALLATION REPORT ---- MASON COUNTY PUBLIC HEALTH
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Permit Number: swG 12- 001 Tit, Assessor Parcel#: 21 — 500 30
Applicant Name: �c.Mt.4 ry%: r� Subdivision(Name/Div/Block/Lot):
Address: 55 cp
City/Stata0p: S�Le.� +�. (ii6 9e��. In rName: '�' C tb
Site Address: +-ISSU C (3iac,K oI.-� fZ Name: T�a0._ LiCeF �2F'r
GENERAL:
Full System Installation ❑ an k Ilation ❑ DralnfieW Installation Only
Tanks: Septic Tank OPUmp Ta .Pomp Basin ❑Grease Tmp
Treatment: ❑Sand Filter ❑Mound ,1 Sand-Lined Drainfiekl O Glendon BioFiner
❑ATU ❑Recirc.Filter ❑Other:
Drainfield: Gravity Dist. ❑Pressure Dist. ❑Sub-Surface Drip ❑Other:
WAIVERS Comments'
Waivers needed for the installation of this svmem?............. OYES NO
Were waiver mitigation measures followed?........................ ❑ YES O
SEWAGE TANKS&TREATMENT COMPONENTS:
TANK&TREATMENT UNIT SETBACKS MET? WAIVER/MITIGATION
>100'from public well....................................................__._...... TO YES O NO
y.
>5('from private well,drinking spring/surface water........ YES❑NO
>30'from water supply lines..............._........._........................ PrYES CINO
>S'from foundations,prop./easement �./
lines,downgradiern tyf�YES❑NO
curtain/foundation drains,ditches................._.........._.._......... pr YES❑NO
Stormwmer component setbacks met?................................... Vr YES ONO
All tank inlets and outlets water-tightjoined water-tightto cast-in adapters?......................... YES ❑ NO N/A
All tank risers joined with watertight sealant to cast-in adapters?..............................._........... )dYES ONO ❑ N/A
All tank lids water and gas tight?....................................................................................._I....... WYES ❑ NO ❑ N/A
Final grade in tank area sloped to divert standing water away?................................................ VYES El NO O N/A
ES 11 NO LI N/A
Tank Inlet/outlet/connector Pipes ASTM9034 or better?.........................................................
Owner informed electrical connections must be made by owner or licensed electrician and ❑ ONO N/A
inspected by L&I?.......................................................................................................
.........
_.....
YES
systemhard-wired?.................................................._............................................................... El YES ❑ NO N/A
SEPOCTANK GREASE TRAP
Cleanout between building and tank?....... YES❑NO nout between building and tank?......... ❑ YES❑NO
Tank baffles present/functional?............... AYES O NO Tank es present/functional?...........-...- ❑ YES O NO
Tank dividing wall present/functional?..... Q. Y'ES❑NO 24"access rs over each compartment?.. O YES❑NO
24"access cis r each compartment? !r t,/YES❑NO Tank material: Concrete- ❑Fiberglass O Poly
Septic tank fluent fi#e ake/model: r'
�Ft'K0 Tank mfg:
Tank material: I Concrete O Fiberglass ❑Poly Size of grease trap compartment
Tank mfg:
S7 SMher: #1 #2 #3 #4
Size of septic tank compartments(gal):
#13 Lu__#2 ��0 #3 #4
Page 3
TRANSPORT LINES:
SETBACKS MET? �r. WAIVER/MITIGATION
>300'from public well..................__._._._._._._.........._._.. � YES 0 NO
>50'from private well,drinking spring..................... ffYES O NO
>10'from surface water&water supply lines..................._. JET YES O NO
>2'from foundations............................_....................._............ YYES O NO
Stormwater component setbacks met?................ {YES O NO
Transport line size: 11
Class/schedule: Jb3q Check valves installed? ❑ YES ONO
Man#olds/Splitters Boxe t� D-Box water leveled&s d levelers used? )(YES ONO
accessible&adjustable from surface?...........,p:r YES O NO Leveler model: e
DRAINFIELD & RESERVE AREA:
DRAINFIELD SETBACKS MET? WAIVER/MITIGATION
y
>100'from wells,drinking spring,surface water?................ Cr YES 0 NO
>50'from downgradient cuts/banks with 6'soil
above restrictive layer............_.................................._..__......... lt'd'YES 0 NO
>30'from downgradient certain/foundation drain/ditch...... RYES 0 NO
25'from downgradient cuts/banks with>5'soil
above restrictive layer..._.........................................._.............. %fYES ONO
>30'from water supply lines,decom.well, foundations_..... WYES O NO
>5'from property&easement lines_............._.._................. N x!YESONO
Stormwater component setbacks met?................................ WYES ONO
Date of drainfield installation: g-x-13 Depth of cover over drainfreld:
Drainfield installed in dry soil conditions?........%PESO NO #Yards of cover used:
Gravel used? )KYE50 NO Size: I/T Clean?VYE50 NO Type cover material used(i.e.sand,loam): C
Gravellessused? ❑YESVNO Make/model: Cover material sour srt it,etc)
CERTIFICATION OF INSTALLATION:
INSTALLER DESIGNER
I certify that I installed the system in accordance with the I certify that the system has been installed in accordance
septic design stamped-APPROVED"by MCPH and that any with the septic design stamped'APPROVED-by MCPH and
deviations shown here have been cleared/approved by both that any deviations shown here have been
the designer and MCPH and meet all State and Mason cleared/approved by both myself and MCPH and meet all
County codes. State and Mason County codes.
I further contained on this form Ifurther certify that all information contained an this form
i and the attached R rowing is acc
u q-11ur e.
rg ature of Installer Date
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and 3
Record Drawing an behalf of Mason County Public Health: ,o
EALF`,
Sgnalure of Env.Health cialist ��C•I Date s'
Comments
(Designers Stamp,Signature&Date)
QO.84V VGL.S 0A4'*GLS
1 2
3000PD PRUARY d
RESERVE DRAWFIELD
SOIL LOGS
h
cf
12000AL SEPTIC TANK /' i •��---DRIVERARKING
4 .
APROXSHOPWWDDW `
480GPD PRMMRYB
' RESERVE DRAINFIELD '4
i
WATERLINES
t
10VR
/ DRIVES
WELLAPRDX POWER MC PUBI VED
PIMP HOUSE A,I, ocr g H1?i
2o�z
APRDX HOUSE LOCATION Aoll
FR
PROPERTY LINES
SITE PLAN OVERVIEW(MOUSE):
FOR: MEDCALF JOB#:
PARCEL*42125-14-50030 DATE:01 OCTOBER 2012
BY:TJS DESIGN PAGE OF_
NORTH ARROW: SCALE: 1"=2W
D' 1
0 TANJASYRETT DESIGNS