HomeMy WebLinkAboutSWG2006-00828 - SWG As-Built - 4/27/2007 [ft tILLOWL GU1f/LL' cLLVLLI: <lCLLG4/L
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Pemut Number SWG 2006 _OG Assessor's Parcel# OU 3 - D
ql
q (Twelve-Digit umber)
�P11 Subdivision /L1
Applicant's Name p[ ^ T C (NameMivisio�lock/Lot)
Applicant Address D 3, MAR h-tV# installer's Name ,
St k�o� �Jn�� q
City,State,Zip J4 'WD (`Designer's Namla.
#hiro;.Jsiit_r �, ,%r ,q;( `iy hN.t. INSTALL+ER CHEIS1Ts' 3r `5,'d`r , 3T..y ' -v ;
N/A Yes Prior to Completion
1. SEPTIC TANK
>5 ft. From foundation?................................................_.......... ❑ ❑
>50 ft from wells? .................................................................. ❑ JE( ❑
>50 ft surface water? .......................4...................................... ❑ X ❑
Building stubout to septic tank:cleanout if not 1-2%? ......4............ ❑ 1W ❑
Baffles intact and clean?......................................4........_......... ❑ p
Dividingwall intact?........................................4......._.............. ❑ �( ❑
Risers installed for access?...............................................
._...... ❑ ❑
Screen basket effluentfilter tailed?(circle one) ......... ❑ p ❑
Tank size:_QAjj gal.; Manufacture: KO{LXS
D. D-BOX
Leveled with water? ................................... ..................... ❑ ❑
Speed leveler used? ............................................................... .� ❑ ❑
III. Drainfield u
>10 ft from foundation?....................................................... ❑ ❑ )o.
>5 ft from property lines and easement lines? .......................:...4. ❑ :131 ❑
> 100 ft from wells?............................................................ ❑ ❑
> 100 ft from surface water? ................................................. ❑ X ❑
.... ..>10 ft from potable water lines? ......... .... ...4...................... ❑ ❑
Laterals]eve'Lto±1 inch&end caps present if not looped?.............. ❑ X ❑
Gravelless chambers utilized? ................................................ )d ❑ ❑
Gravel clean,properly sized,and proper depth?...............6........... ❑ ❑
PRESSURE SYSTEMS
Sand quality ASTM C-33? ..........................................
Head height uniform >24 inches? Actual head height—LiEL ❑ ❑
Clean-outs and observation ports present?......................... ❑ ❑
Mound: Side Slope 3:1? ............................................. $( ❑ ❑
Owner informed electrical connections must be made by
owner or licensed electrician and inspected by L&I?.............. ❑
IV. PUMPIPUMP CHAMBER
Pump make km
nk0i,e. ; Pump model SP ❑ )Sr ❑
Chamber sin l\131 gal; Manufacture 11< Lts ❑ ❑
Height of pump off bottom of pump chamber U inches
Pump chamber draw-down _0� gallons per inch per minute
Pump capacity at) •Olo gallons per minute
Pump controls:Timer, Elapsed Time Meter,Counter?(Circle all that ❑ '16, ❑
apply). If timer:Pump On Pump Off
Riser installed for access?......................................................... ❑ it ❑
rk :A�jssrr installe ?... ......................... ... ....................._.........
CBECKUST
❑ Drainfield& ,
manifold orientation
&layout
❑ Trenchlbed
dimensions and
critical distances
within layout
Cl Septic/pump tank
placement
❑ Location of
buildings
❑ Observation port&
clean-out location
❑ Location of wells&
roads
❑ Undisturbed native
soil between
trenches
❑ North arrow
'o
CAUTION:Minor adjustments to septic mnk location and draiafteld orientation made in the field by the installer are¢¢enerally acceptable
to both the department and the designer,but could in certain cases compromise the viability orthe system. It is the installer's responsibility
to obtain prior wriaen approval from either the health de artment or the designer before making any deviations from the design that affect
the system viability. Any deviaromfrom the approved deerign must beshown above.
r'A.. r ,i Rt v HF':.•l' 'L^'}.W14, t,
.tt.i1 �. tir.,�'r rrst^. a*-.o.. c. GERTIF�CvATIOO IN,OF,uINS'A'AtiliAT10N-❑c={',.fr' <i:.:, .a.'•fet.°l-.: ?rit;',
Ins I r: Check a box from Row"A" and"B",sign and date the certification
A. I certify that I installed the system without any ❑ 1 certify,that all deviations from the design stamped
deviation from the design stamped"APPROVED"by "APPROVED"by MCPH are shown above.
MCPH
B. A I certify that 1 contacted the designer and left the .❑ I did not contact the designer prior to final cover because the
system open for inspection up to 48 hrs prior to cover. designer e e notification requirement.
I further certify that all information contained on this form is accurate. I understan4 that ifWe inf lion contained herein is not
accurate,there will be just cause for immediate suspension of my installer certifican n.
- 19- 0
ignature of Installer Date
The undersigned approves this installation on behalf of Mason County Public Health. /
C/N Y Z6 0�
Revi 0