HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 6/3/2009 h1'tlt TW Tgi-T 1l)-Jv, 1T . ...ulY Jrctru rw i✓e. I ntrr/l w.r.
RECORD DRAWING ASBUII, C ; Mason County Public Health
PARCEL IDENTIFICATION
Permit Number SING _ Assessor's Parcel# /�A09 34 non
'� 1 (Twelve-Digit Number)
Applicant's Name TEotNA �OI1 w. N4 a75 -S191 Subdivision
(Nm=/Ditdsion/Block/Lot)
Applicant Address P.O. lox
\ -59 2. huWler's Name
City,State,zip N �t�1 F_. _9_B 5 Z� Designees Name
INSTALLER CHECKLIST
N/A Yes Prior to Completion
L SEPTIC TANK
>5 ft.From foundation?................................................_......... ❑ ❑ ❑
>50 ft from wells? ....................................................._..:....... ❑ ❑ ❑
>50 ft surface water? ..................................................._........ ❑ ❑ ❑
Building stubout to septic tank:cleanout if not 1-2%? ..............:: ❑ ❑ ❑
Battles intact and clean?........_......................................_........ ❑ ❑ ❑
Dividing wall intact?...............5.................................-...........
_ ❑ ❑ ❑
Risers installed for access?..............................................._..... ❑ ❑ ❑
Screen basket or effluent filter installed?(circle ore) .._...._........ ❑ _ ❑ ❑
Tank size: gal.; Manufacture:
It. D-BOX
Leveled with water? ............:........................................... ❑ ❑ ❑
Speed leveler used? ....................::................................... ❑ ❑ ❑
:III. DRA SFIELD ... -.
>10 ft from foundation?.................................................... ❑ ❑ ❑
>5 ft from property lines and easement lines? ......................... 0 ❑ ❑
_ .> 100 ft from wells?......................................................... ❑ ❑- ❑
> 100 ft from surface water? .............................................. ❑ ❑ ❑
>10 ft from potable water lines? .......................................... ❑ ❑ ❑
Laterals level to±1 inch&end caps present if not looped?............. 0 ❑ ❑
Gmvelless chambers utilized? ................................................. 0 _ ❑ ❑ -
Gravel clean,properly sized,and proper depth?........................ ❑ 0 0
PRESSURE SYSTEMS .
Sand quality ASTM C 33?............ ........._................._... ❑ ❑ ❑
Head height uniform n4 inches? Actual head height_ ❑ ❑ ❑
Clean outs and observation ports present?...................... ❑ ❑ ❑
Mound: Side Slope 3:1?............................................ p ❑
Owner informed electrical connections must be made by
owner or licensed electrician and inspected by L&I?............. ❑ ❑ ❑
Iv. PUMP/PUMP CHAMBER
Pump make ; Pump model ❑ ❑ 0
Chamber size gal; Manufacture ❑ ❑ ❑
Height of pump off bottom of pump chamber l inches -
Pump chamber draw-down gallons per inch per minute
pump.capacity gallons per minute
Pump controls:Timer,Elapsed Time Meter,Counter?(Circle all ❑ ❑ ❑
that apply). If timer:Pump On Pump
Off
Riser installed for access?...................................................... ❑ ❑ ❑
Alarminstalled?............................................................_......_ 0 11 0
i
� 40CF S
RECORD DRAWING
CHECKLIST
❑ Dramfield&
manifold orientation 1111
&layout 2101 F„ H 3071
❑ Trench/bed (� V ly VIA .
q
dimensions and rY V 1 W
critical distances
within layout
❑ Septic/pump tank � 3
placement y�
❑ Location of \ t''�g•
buildings
-❑ Observation port& 1 *IOYYIt I
clean-out location �J tip 32
❑ Location of wells&
roads • +
❑ Undisturbed native
@}
soil between
trenches
❑ North arrow I\
,04 �) 10�IFFaM FaW ncwisw[s+�e lw a3
Z 0
ktD V77� 41 3
3
CAUTION:Minor adjustments to septic tank location and drai�eld orientation made in the field by the installer are pelnerally acceptable
to bgh the department and the designer, but could i certain cases com romise the vi bility o�thesystr..Its I ins let's resppnstblliry
to obtain prior written approval from euher the heath de artmeru or t ie designer be]�ore ma mg arty evimrons om the design t at ec[
the system viability. Any devianons from the approved deign must be shown abave.
CERTIFICATION OF INSTALLATION
Installer: Check a box from Row"A"and"B",sign and date the certification
A. ❑ I certify that I installed the system without any ❑ 1 certify that an deviations from Use design stamped
deviation from the design stamped""PROVED"by ""PROWD"by MCPH are shown above.
MCPH
B. ❑ 1 certify that I contacted the designer and left the ❑ 1 did not contact the designer pnor to final cover because the
system open for inspection up to 48 hrs prior to cover. designer waived the notification,requirement.
I further certify that all information contained on this form is accurate. I understand that if the information contained herein is not
accurate,there will be just cause for immediate suspension of my installer certificatl
8i .a t Leco
af-hike ar D to
CA�m a Arb�t4!
The undersigned approves this installation on behalf of Mason County Public Health.
Envimmnental Health Specialist Date
Revised January 2008