HomeMy WebLinkAboutSWG2022-00139 - SWG As-Built - 6/24/2024 RECORD DRAWING (ASSUILT) pg. d _MASON COUNTY PUBLIC HEALTH
PARCEL, IDENTIFICATION
Permit Number SVVGZQ Z,-00 Assessor Parcel# i Z_6 3�T,009 f
Applicant Name ucr (��� � 1, Subdivision (Name/Div1131oc /Lot)
Applicant Address
c; cam 2 �d�FN-fit _.
City, Stare, Zip wa. $b eLT -__ Installer Name K Pk
Site Address C; Ql, L:2 mn.4 ,,', riVe-�,Y"+esigner Name
INSTALLATION CHECKLIST
0 Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ^ Repair
Systern Type t- 6"3A _ :D Pretreatment Type -�
=5 ft, from foundation? -- - - - - ---- --- --- ----- --- -- - - L-] NIA Yes ❑ No
%50ft, fromwells? - - _ _. _ ._ _ _ - .__ --- _ _ _ _ __ _ _ _ __...__ - ❑ ❑
>50ft. from surbacervater? - - .. _ __.. - _ _ _ __ _ _ _ _ _ _ _ .. _ _ - ❑ ❑
st Cleanout between bul'dil-g and tank? --- ----- (❑ ❑
L) Tank baffles present? - - -- - -- - -- -- - - - - - --- -- - --- - - - - ❑
k- 24" access risers over each compartment?--- - - - - - - - --- ---- ❑ �] ❑
W Effluentfiltei installed?--- -- - - - - ----- -- - - - - -- -- - - - - - - - -- -- - - ❑ ❑
tlJ
Septic tank size I ')-0U _gal Manuff ran
i
D-box water level and speed levelers used? -- - - -. -. ._ _ _ ___ -. _- ❑i N/A ElYES ❑ No
0w Manifold/D-box accessible from surface?-- - -- -- - -- - - ---- 2 ❑ ❑
N?;G. Check valves Installed? . - - - - -- - - - - - - - - - - ----- - --- __ ❑
7$
Transport tine Size 2 �` _ Sohadule(Class,___��Z
Bedrooms installed(check one) ❑ 2 Q] 3 ❑4 ❑ 5 ❑G i I
,itft. from foundat:on?- - - - -- - - - - - - - - - - - - - - - - - - - ❑ NIP. 0YES ❑ Ne
-100R fromwel!s?--- - - - - --- - - --- - - - - __ .. _. .__.._- _ - ❑
PA7 >100 ft. from surface water? - _. _ .._. .- _-. _ _._. _ _ _ __ _ __ ___ _- ❑ �• ❑
>104- from potable water line,?- - -- ---- - - - - -
_ _. ._-. _ .. _ _. ElElZ
s" 5 ft. from property lines and easements?--- - - - - - El 0 El
[2 = 30 ft. from clov✓ngradient cumin/foundation di-eins? ----- - - = µ- ❑ ZI 0
Drainf!eld level and observation ports present - - - - - - -- I] Or P t' ❑ ❑
I ❑ Graveless chambers or ❑ User gravel used? (check one)
?roper cover installed overdmInfield?-- --- - - - - -- - - - -- --- 00,,,ro ❑ ❑
Pump tend setbacks consistantwith septic tank? ------ [] NA YES ❑ No
Pump tank size,y,�, Cl gal Manufacturer___!. _r.n-�__
Q24" access riser(s)and accessible fi'om surface? - - -- - - ---- --7 v
D. Alarm or Control Panel lnstalied? --- [] E ❑
Control Panel equipped with Timer/ETM/Counter-r --- - -- - - -- E] �]" ❑
�7
Purrp installed in Bucket or On Block or n Other
II Pump Make/Mode!_S--f- Lv 4'o (a, _ ,`ZFlosts or ❑I Transducer
tl D. Tank dram+/down.- 1 % inlmin l um P ca acity Squirt Height,
IIII 'Pimp or, time g;,t Purnp off time �,�y _ Dally flow set at"k," _gorn
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RECORD DRAWING (ASBUILT) Dig. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
i 'orjold&
manifold oriantr'dos
a layout
Trenchlbed
dimensions end
gttlral dlsiences
within layout
placement tank
plsoemenP
C� Location of
buildings
Fj Observation parts&
cleao-mn locations
u Location of wells,
surface w2tat s
roads
Q Undisturbed native
soil between
trenches
n North Aaow if the the deal an or or Installer feel the need for additional Informationloomorents,it may,be attached.
Record drawing may also be on a separate page attached._ Na Pages Abashed_
—,--,----CERTIFICATION e, ,--- CERTIFICATION ®F INSTALLATION
INSTALLER it 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 clearedfapproved by both the designer shown here have been cleared/approved by bath
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Meson County Ccdea State and Mason County Codes
I further certify thateB Information contained on this I further car ify that all informsh'on contained on firs
form and
aaftt_a'e_hed Record Drawing is accwane. form and atlaenod Record Drawing is accurate.
signaab".of installer Data y_
ti
Printed Name of Signee
MASON COUNTY PUBLIC HLAL1"NL
The undersigned approves this Installation Report end
Record Drawing on behalf of Mason County Public
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SrgrabrF n 6Flt onmi r to Health bpecln6st Date (das)g)dd s stamp signature antl date)
THIS FORM,MAY RE S0ANNFp ANO/rVAl1ABLE FOR PUBLIC VIEW ON THE MASON COUNT WEB SITE
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