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Home My WebLink AboutSWG2021-00638 - SWG As-Built - 5/20/2024 RErjORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG a(�2 Assessor Parcel# ZLo i q -SL- 60.7c1 1 Applicant Name tFAv P,"rz 1h>w. r one LC Subdivision (Name/Div/Block/Lot) Applicant Address )?0 L3mK 2�-t 1 KcLSc1 i--4,2, L.,r _ City, State, Zip W w q Ss 62L _ Installer Name �l•....` u,-G Site Address 2 )- yw .,esigner Name INSTALLATION CHECKLIST ® Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair _ qFC 41 System Type Pretreatment Type >5 ft.from foundation? -- - --- --------- ----- ❑WA ®YES ❑ No >50ft. from wells? - - ---- ---- -- --- ---- - - - ------- ❑ ❑ Z >60ft. from surface water? - --- ----- -- - - ---- - - ------ ❑ ® ❑ F Cleanout between building and tank? --------- -- - ------- ❑ ® ❑ 0 Tank baffles present? ---- --- -- - - - - -- --- - -- ----- ❑ ® ❑ a24"access risers over each compartment?--- --- --- ------- ❑ ® ❑ LU Effluent filter installed?-- - - - -- --- - -- - - - -- -- --- ---- ® ❑ ❑ Septic tank size ILoo gal Manufacturer ❑ D-box water level and speed levelers used? -- ---- - - ------- 0NrA ❑Yes No J QO Manifold/0-box accessible from surface?----------- ------ ❑ f a1 a?z Checkvatves Installed? - - - --- - - - - - - - - - -- - -------- ❑ ® Q a Og s Transport Line Size I u SchedutefClas �t C7 i -� b Bedrooms installed(check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 r >10 ft.from foundation?-- ------ ----- - - -- --- --- --- ❑ WA 0Yss No• >100 ft, from wells?---- - - ---- -- --- - -- - -- -- ------ ❑ ❑ a17 y >100 ft. from surfacewater? - - - ----- - -- -- - -- - - ------ ❑ m ❑ u- >10ft. from potable water lines?------- --------- ----- - ❑ cL. j ❑ ❑ Z > 5ft. from property lines and easements?-- - - --- -- - - - - -- - ❑ ❑ 4 � > 30 ft.from downgradient curtain/foundation drains?- - --- - - -- - � )� ❑ Drainfield level and observation ports present ---- - ® ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?---- -- - - {,l4`1�-- -- ❑ 4n ❑ Pump tank setbacks consistent with septic tank? ----- --- ----- ❑ NIA QJ Yes ❑ NO Y Pump tank size 12.00 gal Manufacturer_1-iq,ge� Q24"access riser(s)and accessible from surface?-- --- --- ---- - ❑ ❑ t— o. Alarm or Control Panel Installed? - -- - -- - - -- - - -- - - -- --- ❑ ,© ❑ M Control Panel equipped with Timer I ETM/Counter- - -- -- -- - -- El �' ❑ O. Pump installed in ❑ Bucket or On Block or ❑ Other Pump Make/Model S Y Floats or ❑ Transducer D Tank draw down Z in/min Pump capacity 2.o gpm Squirt Height M4Lie rt Pump on time Pump off time 1. 15 Daily flow set at pm .,.uti vnau RECORD DRAWING (ASBUIlT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING ri OnUrifield 8 manRob one"Inflmn &Inyo0 TrancMbed dimenaians and critical distances mft layout EJ sepwoump tank placement iA6on o[buildings buildln9e n I Observation ports,S cle."ut ations Location of wells, Surface vat".& roads ❑ Undisturbed native soil between trenches North Arrow If the designer or installer feel the need for additional Informatwn,'comments,it may be attached. Record dravring may also he on a separate page attached. No.Pages Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER I certify that I installed the system in accordance with I certify that the system has been instalfad in aCc,,- the septic design stamped'APPROVED"by Meson dance evith the septic design stamped'APPROVED"by County Public Health and that any deviations shov✓n Mason County Public Health and thatany deviations here have been cleared/approved by both the designer shown here have been clearedlepproved 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 inromnetion contained on this I further certify that all information contained on this form an tfe bed Record Drawing is accurate. form and attached Record Drawing is accurate. ' &2o z,-( Signitttuure of installer —� Date �Y(' !_ 9a. rtr Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalfof Mason County Public Health., Vf /� ^ °1 ..Aonrn J.Hurvren S LiL�CNCp,761'S'i:NY.r7... Signature of Environmental 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 raa�arnvmi: 2@@@@a@@@a \ | � c Z � O � % ® § ' co_@ & ~ | ® ) § / N2 % o a . � � . . � . . � K � y . . 4li . /y . x a � ' z � , 2 / `§ ) ) � \ ] | r - ^ Ir £ § @ ( � ©42 ® ¥ ) ) ) \ � � � � � ` ) § ` ! \ { \ ) � § § ( ! - § � f � § § \ .