HomeMy WebLinkAboutSWG2019-00280 - SWG As-Built - 5/10/2024 RECORD DRAWING(ASBUILT) pg, 1 MASON COUNTY PUBLIC HEALTH
Permit Number SWG /f O Assessor Parcel# ", .j2�-3/-SoPJ�.v
Applicant Names. I hAm vrlc��/ Subdivision(Name/Div/Block/Lot)
Applicant Address &,r_ /�
City, State, zip Salrn 1Lyte. �olnstager Name.. Mn k& AECdgr +r ike, L L e-
SfteAddress c2o( C�- Vryc-��— Designer Name Iv✓\
,�.Full System Installation ❑ Septic Tank Only ❑ Drainfleld Only ❑ Repair
-� System Type_ Pre. XLV4E. &. Pretreatment Type
>5ft from foundation? --------------------------- ❑WA YES - ❑ NO
>5oft.from wells? ----------------------------- ❑ ❑
>501.from surface water? ------------------------ ❑ ❑
cleanout between building and tank? ------------------- ❑ ,®, ❑ '
Tank baffles present? ---- ----------------------- ❑ ❑
-24'access risers over each compartment?---------------- ❑ ❑
a
Effluent filter installed?-------------------------!-- ❑ ] ❑
_ •Septic tank size al Manufacturer dUr��vO� !'li?Ceoor�c�r
D-box water level and speed levelers used? --------------- ®.WA ❑Vas NO
- Manlfold/D-box accessible from surface?---------------- .® ❑ ❑
;. Check valves installed? ----------- ---- ----------• II�. ❑ ❑
a Transport Line Size N Schedule/Claw
.," ..
Bedrooms Installed(check one) ❑ 2 IJ,3 ❑4 ❑ 5 ❑5
«r'^ '>10 ft.from foundation?-------------------------- ❑ MA ,®VEs NO _
�>100 fl.from wells?-____________________ _______ ❑ � ❑
>too ft.from surface water? --___ __ ________ _____- ❑ ❑
h' >10ftfrom potable water lines?------- --------------- ❑ ❑
>5ft.from property lines and easements?---------------- ❑ s❑C1 ❑
x>30ft.from downgradlent curtain/foundation drains?---------- ❑ 0 ❑
Drainfleld level and observation ports present - ---- --- ❑ ,[�] ❑
❑ Gmveless chambers or ,RL Clean gravel used? (check one)
rx7
Proper cover Installed over dreinfleld7-- ---------------• ❑ f]W, ❑
k Pump tank setbacks consistent with septic tank?------------- ❑ NIA ,® YES ,y NO
-,,Pumptanksize /e166 gal Manufacturer��Is�4 ��Ca-6•�'W-'/
-24'access rlser(s)and accessible from surface?------------- ❑ (e$ ❑
Alarm or Control Panel Installed? --------------------- ❑ ❑
Control Panel equipped with Timer/ETM I Counter----------- ❑_ ®„ ❑
Pump Installed In ❑ Bucket or IiPVOn Block or ❑ Other
Pump Make/Model 'Z) � ..5-� .�Floats or ❑Transducer
Tank draw down Ou WrW Pump rapacity pm Squirt Height S b ft
Pump on time Pump olf time Dolly flow set at (O,lo opm
.w d la 14
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
DalnfieM&
manifold orientation
&layout
Trenchbed
dimensions and
critical distances
within layout
Sepbo'pump tank
placement
Location of
buildings
pu Obsernati ns&
c%an-buMation.
Locenon of wells,
surface water.&
rued.
Undisturbed native
soil between
branches
❑ North Aimw
If the designer or installer feel the need for additional infonnafionloomments,it rimy be attached.
Record drawing may also be on a separate page attached. No.Pages Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
1 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 Meson County Public Health and that any deviations
here have been clearedtapproved 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
and Mason County Codas. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form aannddaattacheedd Record Drawing is accurate. �j q form and attached Record Drawing is a urate.
i nfab, Installer Date _z.}
Printed Name olSignee Py.,`� 3""'•.
MASON COUNTY PUBLIC HEALTH 3-
The undersigned approves this Installation Report and °w`rt v1��fS
Record Drawingon behalf of Mason County Public LICENSED
nr Wr _
ty it JAIAL +K tlrR
scs�cs z
Health.' E �wts: 18,.2/u
signature ofEr�vintomentail Health Specialist Date (designer's stamp,signature and date)
THIS FORM MAY BE SCANNED ANDAVAILA13LE FOR PUBLIC NEW ON THE MASON COUNTY WEB SITE
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