HomeMy WebLinkAboutSWG2022-00077 - SWG As-Built RECORD DRAWING (ASBUILT) pg. t MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG - - 7pOI7 Assessor Parcel# V/ 4 L )- 3,1 -000a u
Applicant Name &Cwu [,�J,4 Subdivision (Name/Div/Block/Lot)
Applicant Address t o l l f{'�4i/�3o 1 Ave-
City, State, Zip 01 n ;w
Y P �.(° ZWA u.SSUZ Installer Name
Site Address `/`/66 W ,Stale 0J Designer Name Goal%.
INSTALLATION CHECKLIST
f. Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type Sl` //'V IPre-0S.vc_ Pretre tment Type
>5 ft.from foundation? ---------- ❑ NIA YES ❑ NO
150 ft. from wells? - -- ---------- - -�---u--ll--- ❑ �`' ❑
Y >50 ft. from surface water? --- - ----
_ - Mav-o-2 zaza- ❑ ® ❑
FCleanout between building and tank? --- - ----------- ❑ ❑
O Tank baffles present? - - -- - - -- -- -- - ❑
C24' access risers over each compartment?- B ❑ ❑
N Effluent filter installed? - -- -- - - ❑ ($ ❑
Septic tank size nZ gal Manufacturer ,�wel �aco�..rrL
LJ] D-box water level and speed levelers used? - -- ------------ [3 WA ❑YES NO
Q.tO Manifold/D-box accessible from surface?-- -- ------------- ❑ ® ❑
06 Check valves installed? - --- -- -- - - - -- - - ---------- --- - El ❑
2 Transport Line Size 2 Schedule/Class 'Zoo
Bedrooms installed(check one) ❑ 2 ❑3 [R4 ❑ 5 ❑5
>IOft. from foundation?-- --- -- -- -- --- ----- --- --- ❑ IAA ® YES NO
>100 ft.from wells?-- - -------------------------- ❑ IR ❑
W >100 ft.from surface water? ------------------------ ❑ ❑
li >10 ft.from potable water li nos?- --- ------------------ ❑ ® ❑
QZ > 5ft. from property lines and easements?- - -- - ---- ------- ❑ IN ❑
K > 30ft.from downgradient curtaintfoundation drains?---- ----- - ❑ 21 ❑
Drainfield level and observation ports present - ------ - -- -- - - ❑ ® ❑
[3 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?------- --- --- - - -- --
Pump tank setbacks consistent with septic tank? - - - - - - ------ El WA p7J YES ❑ No
ZPump tank size [t-00 oal Manufacturer .(:D"j PL'Cer., L-
24"access nser(s)and accessible from surface- ------- ---- - ❑ ® ❑
aAlarm or Control Panel Installed7 - - --- -- - - - ---------- ❑ [RJ ❑
Control Panel equipped with Timer/ETM/Counter ❑ ® ❑
dPump installed in ❑ Bucket Ior On Block or ❑ Other
IL Pump Make/Model L,yi.r�Y C� y 6I M [$Floats or ❑ Transducer
a Tank draw down 3 in/min Pump capacity 757 apm Squirt Height
Pump on time f 13 Pump off time 6: 00 Daily flow,set at .3 b0 gpm
,.,, I.,.
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
❑ Dismal&
manifold orientation
&I"Out
Trenahlbed
dimensions and
o itiral distances
wdhin sy.1
Sepe tank
placement
Location of
Wigings
Oe n ppn3 8 D
Ceanan-00 locations
LOcation of wells,
surfau,water,&
Oads
❑ Undisturbed native
soil between
trenches
North Anow
If the designer or installer feel the need for additional information/comments,it may be attached,
Record drawing may also be on a separate page attached, No.Pages Atlached
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 cleamd/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 Record Drawing is accurate form and attached Record Drawing is accurate.
Signature oflosfalller Date
I ' ✓V1.S vfl )�inC.J
Printed Name of Signee AVdo w's`rr4
MASON COUNTY PUBLIC HEALTH $,'•
The undersigned approves this Installation Report and '.
Record Drawing on behalf of Mason County Public Yf&
AMfmYNeminf8011
Health
Signature ofErvincromentill 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
,.....e 1.11
w 2 :-2222----- ---- :/ 2: 2
/
Nq `
b -
� \ ` `� ® � � ` \
. ) nX, . 2
9�
� |2
. e ��. r . ■
( } }
Al
% / § |pzm
. .
\ § "¥
; 4 | "
2
�pƒ
§o± �
§\\ at. (
, - p ;
eV , u __ _ »9
% ®&4_ &