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HomeMy WebLinkAboutSWG2018-00327 - SWG As-Built - 6/5/2024 RECORD DRAWING (ASBUILT)pg. 1 MASON COUNTY PUBLIC HEALTH PA=FCAT'ONTION Permit Number SWG j0 t9—003or Parcel#5L,l ll51-�4-j Applicant Name Q„,(,� C.._ _ sion(Name/DivlBlock/Lot) Applicant Address S2'I w. Q t}City, State,Zip 471nAA , LY* 9 $S Name uYt �SiteAddress �1 w A 11- r Name �'Ir-e 7c,k INSTALLATION CHECKLIST Full System Installation ❑Tank(a)OMy ❑Drainfleld Only ❑Repair ❑Otter System Type JvL. �--- Pretreatment Type >5 ft.from foundation? >50 fL from wells? - �]NIA ❑YES ❑ NO Y Cle ft.from surface water? - Er O FZ LS lsJ LS v Cleanout between building and tank? - Q El a Tank banes present? . EJUN 0 3 ZOZ4 Ca p 24"access dsers over each compartment?- Effluent filter installed?- B ❑ W Septic tank size gal Manufactur ❑ )-box water level and speed levelers used? - - ❑ NIA ❑YEs �r0 Man'rfokVO-box accessible from surface?- NO = Check valves installed? - - ❑❑ ® ❑ Transport Line Size � D Schedule/Class SC,+El ❑ Bedrooms Installed(check one) ❑2 I53 ❑4 ❑5 ❑a ❑C;Ommerclat/Other >10 ft.from foundation?- - © NIA ❑ YES ❑ No [09 >100 ft.from wells?- ❑>10o ft from surface water?- ❑>10 ft.from potable water lines?. ❑ ❑>5ft.from m ❑ ❑ r p perry lines and easements?- - ❑ © ❑ a >30 ft.from downgradient curiain/foundation drains?- - ❑ © ❑ Drainfiekl level and observation Ports P Present - �. - ❑ O ❑ [>9 Greveless chambers or [:I Clean gravel used? (check one) [j�LA[arm oper cover installed over drainfield?- - ❑ fl ❑ mp tank setbacks consistent with septic tank?- - ❑ NIA ® YES NO mp tank size ifLao gal Manufacturer n.� access neer(5)and accessible from surface?. ❑ ❑ or Control Panel Installed? - ❑ntrol Panel equipped with Timer/ETM/Counter. ❑ ® ❑ mp Installed in Ej Bucket or ® On Block or ❑ Other .ad, Pump Make/Model g.a. I r4 -t;1 Floats or ❑Transducer IL Tank draw down jtVIS INmin Pump capacity laa gpm Squirt Haight_ a I. _ft Pump on time µan. Pump off time 4fl Dally now set at aw q WGeM1LrMa MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# f ^ RECORD DRAWING L ` �/DrelrMeld&manMd � , c/o orientation&hyd wl6manslorn for )Oa re-location. [✓r Trandvbed :i.-a- dlmeneims and afficawithin lut a layout ]casla �- o D-Co.t l WJram/ am G . 0 Ia aeP�PP hN "c I 6 = �L��a'/� plain and u1t" 4 0 �tif 6 see. a, M yo LOC8ti0n of ladkfing3 ads ad 'Up EJ Obsenawnpons, - -; deanaatoratlo:u, &manHdeaidbozea }- , r Qu1v. ...r.T LA) Loj Location of cells, surface water,roads, &watarllnes. ❑ Rmarvearea(s) N` ❑ NorlhA If the designer or Installer feel the need for additional irdonnanoNoomments,it may be attached ` Record drawing may also be on a separate page attached. No.Pages Attached CERTIFICATION OF INSTALLATION Fhave ALLER DESIGNER ify that I Installed the system In accordance with I certify that the system has been Installed in accor- ptic design stamped APPROVED°by Mason dance with fhe septic design stamped APPROVED-by ty Public Health and that any deviations shown Mason County Public Health and that any deviations ave been cleared/approved by both the designer shown here have been cleared/approved by both ason County Public Health and meet all State myselfand Mason County Public Health and meet aft ason County Codes. State and Mason County Codeser cedlfy that all Information contalned On this Ifurther certify ghat all lntOnnagon contained On this im nd attached rd Drawing is accurate. form and attached Record Drawing is accurate. ul��flnstel/erpale Name of Signs MASON COUNTY PUBLIC HEALTH The undersigned approves this Instaliation Report and fi IpP,R �� Record Drawing on beha/iofMason County Pubec �� n0 Md HUNTER Health: J11i Ln<tlrir r.Ae li'' Clay 1 C VW Signature of Environmental HeAfth Specialist Date (designer's stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uw.ustmrzma m � - � '\/ ) � � � _ , _ _ \` i ( \ ° ■ 60, ` ] � \ QUINAULT !PAIL § | - / ? Q } p I ! { § ` 2 = 00 ! 2 \ } \ \ \ \ E § ; / ) ) _ § § ; 23 \