HomeMy WebLinkAboutSWG2020-00289 - SWG As-Built - 6/13/2024 RECORD DRAW NG( r T)pg.1 a�I ASBUIL MASON COUNTY PUBLIC HEALTH -i
PARCEL IDENTIFICATION
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er swo ZOZp - p0281 Assessor Parcel# 3190/l3ooO:o _
me ScAll f tlog• r SubdMsion(Name/DN/BlockAot)
37o � G kl,rt P VA Installer Name» aj Designer Name
,.,,/ INSTALLATION CHECKLIST
Ly Ful SystemlrcbAeean ❑Tenk(s)ony ❑WaInmo* ❑Repair ❑Other
System Type Prooeelment Typsi_4-r
>5Mfromfoundation? - car, ❑No
>50R horn we6t7 - lJ Cf [d o
Y >50 tL from surface water?- f'il
RCteanoutbetween building and tans - JUN ;4 HI J d ❑
O Tank baleen Pr��- ❑
24"access risers over each companmen ��l�V2J!!/// ❑
Wry Emuentercer lnsWb07- ;__J❑ �- ❑
Septic tank sire lSUO sal ManufacNrer Nr�r� Are6A✓r
f9 t}bc:welerlewJ and aped taWan seed? - ❑Nun [lea dNo (
Oro mwft;d 4=eaasulble from surface?- - ❑ [ji ❑
a= Check vakma Installed? • . ❑ ❑
9 Transpod Lt.So. 2, ,�� Schedule/dass SrA Ye
Bedroomainsfalled(checkons) ❑2 V3 ❑4 ❑5 ❑d ❑CommerdatiJppwr
>10 fL hem foundation?- - ❑NIA L�f Yl9 ❑ No f1
>100Rfromwelia?• • ❑ Er. ❑
r� >100e-fromsurfacewater?. - ❑ 21 ❑
i
u. >10(L ons potable water lines?. - ❑ ❑
QZ >5 ti horn property Ilnee and eaeementa7•
K >3UR hen doumgmdiem aetalMrwndation drains?• . ❑ I•] ❑ j
Drafngeld level and ob"Neson..por�ts present• • ❑ [7 ❑ t
❑ or lose chambers or G Mean gwal used? (check one)
Pmpercorer lnsleked over dminMld?- foe ❑ ❑ ❑
Pump tank setbacks consistent with sePtic tank?• ❑ WA vas ❑ No
Y Pump tank She l�aN Manufacturer v
24.eoo a,rieer(8)and accessible from surface?- • ❑
Alamo or Conwd Panel Installed?. a
6 N
f Control Panel�ubp�vdtlt Timer? Counter-
IL pump inetaned In ❑ Bucket or On Bork or ❑ Other �/
pump MakeMlodd urn /./ H�f/I° efiosts or ❑Tlansdu .
a Tenkdrew dkmm ! -r.JNmIn Pump cePadl'/�d gPm SqulAHeight co%kr _ m
r Pump off time_ GI } Dalrygawsetat
Pump On time
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MCPH RECORD DRAWING(ASBUILT)pg.2 Assessor ParcalN
RECORD DRAWING
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CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
I certiydwf llnstalled the system In accordance with l wr*that the system has been installed N accor-
theseptkdssfgndamped'APPROVED'by Mason dance WM the-Pilo design stamped APPROVED'by
CounyPobao Health and that any deviations shown Mason County PUWC Heath and Mat any davledons
here have been deamd/appmvad by both the designer shown here have been deemd/appmVedbyboth
and Mason County Publk Heath andmeel all State mysedend Mason County Publk Heath and meet all
and Mason County Codes. Slate and Meson County Codes
I aathercw*that all arformadon contained on this I A~caAfythat et lnromrdon centelnedon this
lams and to e • ord Drawn Is accurate. form and atpMed Record Drawing is accurate,
ahaaa�mpar Date '
lflr,r Frre.i( fzF'
RlntetlNertrdSgnee � �'
LDmwLV
COUNTY HEALTH t �.
prwea tAls installation Report and l �.
behalf of Me son CountyPubllc
erdalH Spedstat Date (designer's Stamp,signature and date)
TMS FORM MAY BESCANNEDANDAVAIIABIE fORPUBLIC VIEW
ONTHE MASON COUNTYWEB SITE silo Waow
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