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HomeMy WebLinkAboutSWG2024-00045 - SWG As-Built - 5/3/2024 I RECORD DRAWING (ASBUILT) pg.1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number S/WGPO;)`Y-OOoy-s— Assessor Parcel#te .3 a/0 �/<S--O boo3 Applicant Name r /�k--"r Subdivision (Name/Div/Block/Lot) Applicant Address .S'O,�6o.rtr^ -d Z�j 33 City, State, Zip (tea i o rn i rlA 743'.SV Installer Name &L'tw nu--r Site Address , Designer Name INSTALLATION CHECKLIST. ❑ Full System Installation Septic Tank Only ❑ Drainfield Only ❑ Repair System Type G ra 'y Pretreatment Type >5 ft. from foundation? -------------------------- ❑ WA EfYVES ❑ NO . .. 350ft from-wells? --- ------------- ❑ _ � ❑ Z >50 ft.from surface water? ------------------------ ❑ ❑� ❑ H Cleanout between building and tank? -------, ------- ❑ � � ❑ V Tank baffles present? -_____ ___________t? ___ __ d24'access risers over each compartmen ------�---- ❑ �� ❑ W Effluent filter installed?--- -------------- ---- Septic tank size /!i h 0 cal ManulfacWrer N 'A' ftr-x-t0f 0 D-box water level and speed levelers used? --------------- -❑ NIA )R'YES ❑ No 0O. Man"Ifold/D-box accessible from surface?----------------- ❑ ❑ mZ Check valves installed? -------------------------- ❑ ❑ 0M Transport Line Size Schedule/Class Bedrooms installed (check one) ❑2 ❑3 ❑4 ❑5 ❑6 >fOft from foundation?-------------------------- ❑ NIA ❑Ya ❑ No G >100 ft from wells?----------------------------- ❑ ❑ ❑ W >100 It. from surface waterl - ----------------------- El ❑ El o. >10 ft from potable water lines?---------------------- ❑ ❑ ❑ ZG_ >5 ft from property lines and easements?---------------- ❑ ❑ ❑ K >30R from downgradient curtain/foundation drains?----.------ ❑ ❑ ❑ Drainfield level and observation ports present ----- - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check OM) Propercoverinstalledoverdrainfield?------------------- ❑ ❑ Pump tank setbacks consistent with septic tank?------------- ❑ RYA . ❑ YES ❑ No ZPump tank size Nal.. Manufacturer 4 24'access nser(s)and accessible from surface?-- - - --------- ❑ ❑ ❑ aAlarm or Control Panel Installed? ------------ --- ------ ❑ . ❑ ❑ Control Panel equipped,alf'(m( Timer I ETM/Counter-- -- - - - - - -- ❑ ❑ ❑ 0- Pump installed in ❑ Buc1Cp[ -ar ❑ On Block or [I Other a Pump Make/Model ❑Floats or ❑Transducer g a Tank draw down intmin Pump capacity opm Squirt Height ft Pump on time Pump off time Daily flow set at apm mm rmrzoh4 r r RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING Drainflald& manioldorlentatlm T`u'`k8"tyvcrrt. , ;Id dkd a layout bN y - TrendJbed dimensions and critical distances IS afl within layout rpd?mow Septicipump tank _k STL } placement w:(4A� T..Location of �T buildings 28�1 Observation ports Is desi out locations LuohOnafweliar \ atsurface water.& mad. �OLaP suitataetl native sa - //— d between trenches North If the designer or installer fed Ilm need for additional infonnafionlo mments,R may be attached. Record drawing may also be at a separate page attached. No.Pages Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER I car*that 1 installed the system in accordance with I codify that the system has been installed in actor-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 deviadons here have been cleare"ppmved by both the designer shown hen:have been clearedfapproved 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 -- - -(further certify that all information contamed on this I hurthercerl that all information contained on this form mid affach�ed Record Drawing is accurate. tome and attached Record Drawing is accurate. Signahseofinstaller Date ��ll 4� s � rwuu.� �� i y Printed Name of Signea MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: Signature otEirworimeriN keaft SpadaW Data (designels stamp, signature and date)