HomeMy WebLinkAboutSWG2020-00115 - SWG As-Built - 8/5/2024 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
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ARCEL IDENTIFICATION
er SWIG 2020-00115 _ Assessor Parcel # 22221-51-00010
me Cla O to never Subdivision (Name/Div/BIock/Lot)
ress POB..1814ip aaws,Washkgtm 98528 Installer Name Jack Johnsm construction
14451 E Slate Route 106,Belfair Designer Name Michael Staten(Em otech Engineering)
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pressure Distribution Pretreatment Type
>5 ft. from foundation? - - - ❑N/A ®YES ❑ NO
>50ft. from wells? - - - ---- - - - - ------- - - -- - --- - -- ❑ ® El
>50ft.from surface water? - - - -- - - - - --- - --- - -- - - - - - ❑
HCleanout between building and tank? -- - -________ ___ _ _ _ - ❑ 0
U Tank baffles present? - - - - - __ _ _ _ ____ _____ __ _ __ __- ❑ ® ❑
d 24"access risers over each compartment?-----__ _ ❑ ® ❑
____.
W Effluent filter installetl?- - - - ---- - - - - - -- - ----- - -- - - ❑ ® ❑
Septic tank size 1200 gal Manufacturer
G D-box water level and speed levelers used? - _ _ _ _ _ _ _ _ _ __ _ _ -
Qk§�..,,�J ® WA ❑ YESdEl
Manifold/D-box accessible from surface?__ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ❑ ®Check valves installetl? - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ ___ - ❑2 Transport Line Size 2in Schedule/Class Sd'80
Bedrooms installetl(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑S ❑Commercial/Other
>10ft.from foundation?- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ __ _ ❑ N/A ❑ YESO >100 ft.from wells?-- - - - - - - - -- - - - - -- - ---- - --- -- - ❑ ®
w >100ft. fromsurfacewater? - ___ _ _ __ _ _ ____ _ _ _ _ ❑ ® ElZ >10ft. from potable water lines?-- -- - - - - - - -- -- - - --- --- El ® ❑
Q > 5 ft. from property lines and easements?- - --- - - - - -- -- - -- El ® ❑
O > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - _ - ® El El
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?- - -- - -__ __ _ _. ❑ NA ® YES ❑ NO
Z Pump tank size 1200 gal Manufacturer BAAK wtA1^
C 24-access nser(s)and accessible from surface?--- - -- - -- -- -- ❑ ❑ ❑
F
IL Alarm or Control Panel Installed? -- -- - - - - - - - - - - -_ _ _ __- ❑ ® ❑
7
Control Panel equipped with Timer/ETM/Counter-- - - - - - -- _ . ❑ Ela' Pump installed in
�,Bucket or [I On Block or El Other
Pump Make/Model PE Soo 5( 1 Oce y1 Lr]
®Floats or El Transducer
a Tank draw down - N in/min Pumpcapacity 20,
P ty - 5 apm Squirt Height - 3 A ft
Pump on time - 2.`L ✓Yt ran Xb Pump oft time - y ,1�5-
Daily flow set at -27O qpd
upealae rzn�xals
MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# 32224-75-90142
RECORD DRAWING
® DraMOeld&manifold "SEE ATTACHED"
orientation&layout
-1dimeaalaa5 far
re location.
® TrencNbed
dimensions and
critical distances
wilNn layout
® Septicipump lank
placement
® Location of buildings
existinglpropoself See 'A UAB
® Observation pods.
dean-out bonbons,
&manifobsrd cams
® Location of wells,
surface water,roads,
&waterlines.
® Reserve grea(s)
® Nanh Armw
If the designer or installer feel the need for additional information/comments,it may be attached.
Record drawing may also be on a separate page attached. No. Pages Attached 1
CERTIFICATION OF INSTALLATION
INSTALLER 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 clearedlopproved by both the designer shown here have been clearedlapproved 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 information contained on this I further certify that all information contained on this
form and
(\�t�(,acachadd Record Drawing is accurate form and attached Record Drawing is accurate.
S (me of Installer Data
/ E CLYbf
OF-WAS,SII
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and ''o R 43NS 6/21/23
Record Drawing on behalf of Mason County Public FF, cutsa�°o�
Health: roNALF'
Signature of Environment ;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 unemaa 120r415
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