HomeMy WebLinkAboutSWG2021-00254 - SWG As-Built - 4/16/2024 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH I
PARCEL IDENTIFICATION
Permit Number SWG 2021 -002N Assessor Parcel If 3Z0291 2 Wit 20
Applicant Name "Its SCywnNfY J Subdivision (Name/DiviBlock/LOt) i
Applicant Address 1253 st -jows ICL
City, Stale, Zip A 41)n - 0A Cf AS`YU Installer Name Gnat zpy-e (CRn<kYl)C.�+O'1
P �s ,tr .n aPy
Site Address �^V^^r aC Designer Name n 1 Inn
�.{ INSTALLATION CHECKLIST
t�Full System Installation ❑Tank(s)Oniy ❑Orainfiew Only ❑nepair ❑Olhar/�
_ System Type Pretreatment Type ,.`
>5 ft.from foundation? ------------------------ --" I�NIA Nlyes El No
>50ft.from wells? -_---------------------- - a ❑
Z >5o ft.from surface water? ------- ------- --------- ❑ 0
HCleanout between building and tank? ----------- - --" ❑ ❑
O Tank baffles present? ------------- --------" - ---- ❑ ❑
N 24"accessnsers over each compartment?---- ------------ ❑
a ---------. ,�y ❑
W Effluent filler installed?---------- ❑ `7a
Septic tank size IC al k_
q D-box water level and speed levelers used? -------------- ❑WA ®Y NO
00 Mandold/D-box accessible from surface?---------------- ❑ ® ❑
m= Check valves installed? -------------------- - ,t('•'-I
ca /II Scn@gyl -�(J
S Transport Line Size
Bedrooms installed(cheG�pe) d 2 ❑9 4I--
❑6 ❑CommeryiaVOlher
>loft.from foundation?- -- - ___ .-. ❑WA YES ❑ NO
>100ft.from wells?-__ --r - ❑ ❑
>loo ft.from surface water?---------------.--'� -- ❑ ❑
W ----- ❑
>10ft,from potable waterinea?-.-----------'-' ❑
a and ❑
>Sft.from property lines and easements?----- ----------- ❑
130ft..from downgradienl curtainffoundation drains?---------- ❑ ❑
Drainfield level and observation ports present---------- --- ❑ ❑
[ Graveless chambers or ❑ Clean gravel used? (check one) ❑
Proper cover installed over drainfleld?------------------ ❑
Pump tank setbacks consistent with septic tank?------------ ❑ PUA gym NO
Y Pump tank size 1200 oat Manufacturer 7-jiAllMh)r
a
24'access riser(s)and accessible from suAace?------------• ❑ ❑
~ Alaml or Control Panel installed?---------- ❑ 19 ❑
a c�
� Control Panel equipped with Timer/ETM?Counter---------- ❑ ,4s/ ❑
IL
IL Pump installed In ❑ Bucket or '..1®1 On Bork or Other
I$ Pump Make/Model n(A.l l�l I Z wa F((9 _ {IS or' []Transducer
a Tank draw down
' -� ✓I��,"�',"�k,"-"'""I�INmIn Pump capacity �Q oPm Squirt Height ✓)�� h
Pump on gme yCL(d6�uaLl(.t. Pump oft time h. I Clf]� Daily flow set at 4 �r0 apd
p5(aVe Msek Oscav rvcs2 rr.b,a rsou
a
MCP" RECORD DRAWING (ASBUILT) pg, 2 Assessor Parcel#
RECORD DRAWING
❑ Iminfield 8 mantim
Orientation&layout
widimensions for
n afiw
❑ Trenwiai
dkM.ion3 OM
nilical dielanas Z
WIN"layaa r-
1.4
❑ S"upump lank
plaoement
H
Cl Locae*IWrQnofbulad
emtirq/proppaerl
w
❑ tleanoN laEtlOna,
d manlfoMsldboxea AQl t;
❑ &wwa fi of walla, V
audace watu,wads,
8 watutines.
❑ Reae""au)
❑ NamA ow
If the designer or installer feel the need for additional InrormatioNcanmenm,a met Ee attativw.
Record drawing may also be on a separate page attached. No.Pages Ana&ed
CERTIFICATION OF INSTALLATION
F.nda
ALLER DESIGNER
fy that I installed the system in accordance with I certify that the system has been installed in acoor-
eptic design stamped APPROVED'by Meson dance with the septic design stamped APPROVED'by
ty Public Health and that any deviations shown Mason County Public Health and that any deviations
have been c earalkapproved by both the designer shown here have been clearedfepproved by both
ason County Public Health and meet all State myself and Mason County Public Health and meet all
ason County Codes. State and Mason County Codes
er certify that all Information contained on this I further cenily that all information contained on this
nd attadred Record Drawing is accurate. too=and attached Record Drawing is accurate.
q /lkI
inslalter Date��Y� "Name of Name of Signeee �: "r
1 MASON COUNTY PUBLIC HEALTH
The undersigned appmves this Installation Report and
Record Drawing on behalfof Meson County Public prMMa HUNTER •�
He 'L'l0t?i1S@ti ISKSii:NFR'r"
I l nYi2s o::c L'i
Signal mnmental HesiM Spedalist Date (designer's stamp,signature and date)
THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uama unrm.s
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