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HomeMy WebLinkAboutSWG2019-00085 - SWG As-Built - 7/10/2024 RECORD DRAWING (ASBUILT) pg. 7 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number S W 210 G - \C( — (7( Assessor Parcel# Applicant Name P(W e4tfid:S NLJ / 13u.fber Subdivision (Name/Div/Block/Lot) Applicant Address SaLIMP City, State, Zip 7-wIn0yo- LAM 985'88 Installer Name p��'�'/ yey'?lP.y Site Address - 14L NE LwAe-sfiof� /c or Designer Name oh Ne.-Ile✓ -5001� INSTALLATION CHECKLIST ❑ Full System Installation Septic Tank Only ❑ Drainfield Only ❑ Repair System Type Pretreatment Type >5 ft.from foundation? - ❑ NIA ®YES ❑ NO >50 ft.from wells? - - ❑ ❑ Z >50 ft.from surface water? - - ❑ El r Cleanout between building and tank? - - ❑ B ❑ U Tank baffles present? - - ❑ ' ❑ a24"access risers over each compartment?- - ❑ ® ❑ W Effluent filter installed?. - ❑ IN ❑ f/J Septic tank size looms gal Manufacturer Hvia-" /IPtCsl- o D-box water level and speed levelers used? - - ® NIA ❑YES ❑ No 0O Manifold/D-box accessible from surface?- - ® ❑ ❑ mz Check valves installed? - - ❑ ❑ OQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) V2 ❑3 ❑4 ❑ 5 ❑6 >10 ft.from foundation?. - ❑ N/A ❑ YES ❑ No >100 ft,from wells?- - ❑ ❑ ❑ W >100 ft.from surface water? - - ❑ ❑ ❑ LL >10 ft.from potable water lines?- - ❑ ❑ ❑ QZ >5 ft.from property lines and easements?- ❑ ❑ ❑ 6' >30 ft.from downgradlent curtain/foundation drains? - - ❑ ❑ ❑ Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?- - ❑ NIA ❑ YES ❑ NO Y Pump tank size pal Manufacturer Z ❑ ❑ ❑ F 24"access risers)and accessible from surface?- a Ala"or Control Panel Installed? - - ❑ ❑ ❑ 2 Control Panel equipped with Timer I ETM I Counter- - ❑ ❑ ❑ a. Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump Make/Model ❑ Floats or ❑ Transducer 6 Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpm mom rmaaia RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING J"Drainfield& manifold orientation &layout Trenchlbed dimensions and critical dlslanoes within layout Ry )t Sepoo/pump tank placement dLocabon of buildings Observation ports& deem tlocations Location of wells. suns.water,& roads Undisturbed native flan 3�•F{I� ..it between b senores North Arrow If the designer or installer feel the need for additional infonnasonlcomments,it may be attached. Record drawing may also be on a separate page attached. No.Pages Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER 1 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 cleared/approved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet all State myself and Meson County Public Health and meet ell and Mason County Codes. State and Mason County Codes I further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. D t� 9== 3 c• Signature of Installer Dote Pnnted Name of Signs MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: �p '\�St1JY10� ��IO�Zy Signature of Environmental Ha ph Specialist Data (designer's stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ..+.ee+mrza+o rroperties NW/Barber R-aidence - 142 NE Lakesho-i Dr N, Tahuya WA 9858 E 0 a s R n;� S c h `. y 3 r Sy rt Z y x O 7. O 3 � o � o IpI N O i. N opems .w_reif--,id_c - 142NEukeAmao % rhgaWA98s$ � A©w , a •/¥y � �£ \ ° f } . . . . ) r � � r v ti t � �r o t w a Ro«ri NW/Barber Rr �dme - 14ZNEuwmoru % .mwa _^ vawsa \ 4 � . .� . \ \ ? / '\ » v kkk LLL