HomeMy WebLinkAboutSWG2024-00075 - SWG As-Built - 9/18/2024 ECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2OZY-006'�S- Assessor Parcel # 22U 1� - ba -D6 i�F�
Applicant Name '(A AA ,A4,r &U2tN2- Subdivision (Name/Div/Block/Lot)
Applicant Address 0.0- &X 12091 , LA415rML^11=
City, State, Zip J'L.jn BIzt Loft 7,gOf Installer Name -ArU tAAu1W241-,(--
SiteAddress Ci aq LyKIA''! Y*tf. L•zr� Designer Name VM& tla
INSTALLATION CHECKLIST
�.Full System Installation ❑ Septic Tank Oily ❑ Drainfield Only ❑ Re 'r A
System Type $ Pretreatment Type FC �✓'�
>5 ft.from foundation? ---- ----- - ---- (� N/A ErYEs ] No
>50 ft. from wells? --- - - alaidL Er
1 >50 ft. from surface water? - - - - -- -- - -- - -At)G--]-M4 ❑
Z
FQ- Cleanout between building and tank? - -- - --- - - - --- - - - - Q ❑
O Tank baffles present? -- - - - - BYE ❑
24`access risers over each compartment?-- - - - ---- - -- ❑
a ,�/
W Effluent filter installed?-- - - -- -- -- -- -- -- - - - -- - --- -- ElL� ❑
Septic tank size ju Q gal Manufacturer
❑ D-box water level and speed levelers used? -- - -- - ---- -- - - - ❑ N/A ❑Yes ❑ NO
0J
0 Manifold/D-box accessible from surface?-- -- ------- - -- - -- ❑ 0' ❑
o?Z Check valves installed? -- - - -- - - -- -- -- - - - ❑ ❑ ❑
❑Q H
2 Transport Line Size y Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6
>10 ft.from foundation?- -- --- - - - - -- -- -- - - ❑ NIA NO
❑ >100 ft.from wells?- -- -- - - --- - -- / ❑
W >100 ft. from surface water? ---- -- - -- -- - - - - -- - - - - - -- El l.d' ❑
LL >10ft.from potable water lines?--- - --- -- - - -- -- ---- --- ❑ 51" ❑
>5ft.from property lines and easements?----- -- -- - - -- - - - ❑ 0-� ❑
X >30 ft.from downgredient curtain/foundation drains?- - - ❑ [�/ ❑
7 ❑field level and observation ports present -- - - ------- - --
[�' ❑
raveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?---- --- -------- ---- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?-- ------ --- -- ❑ NIA [1] s ❑ NO
Y Pumptanksize LADD qal Manufacturer 114Fr0_144Tdr'
Q24°access riser(s)and accessible from surface?--- ---- ------ ❑ �' ❑
F
a Alarm or Control Panel Installed? --- -------- - -- -- - - -- - ❑ ❑
2 Control Panel equipped with Timer/ETM/Counter-- - -- - ----- ❑ 0-- ❑
7
0- Pump installed in ❑ Bucket or Eg'6n Block or ❑ Other
0- Pump Make/Model 7e Q 11 At/- Eats or ❑ Transducer
❑ Tank draw down I n/min Pump rapacity SD gpm Squirt Height 3 1 ft If
Pump on time Z+4w Pump off time `f kV Daily flow set at gpm
re 1l 14
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
manifold orientation �f
8layeut b
Trench/bed
dimensions and L.l!
critical distances
within layout
Septiclpump tank
placement
Ei zs Q 53'
Location of
buildings )r J
❑ Observation ports 8 2,I)
rzea -out locations �J
Location of wells,
.ads water,8
ads
ro yf+
Undisturbed native / c
soil between
Trenches / �j�
El North Arrow /1& (�+' �Ptr>//r` 120 t,y6.k0$gb WbLf
If the designer or installerfeel the need for additional information/comments,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 1 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 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 1 further certify that all information contained on this
form and alto be ecord Drawing is accurate. form and attached Reco wing is acc
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Signs ofInstaller V Data p Zu �'IL
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-jorn4rr-<P� ILL L zgAfif.Li
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Printed Name o7Signee
MASON COUNTY PUBLIC HEALTH qte., +"A
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The undersigned approves this Installation Report and o, F4MES L h1M1ER �S
Record Drawing on behalf of Mason County Public LICENSED DESK- Elt
Health:
D;PRFS: o3/22/140
signature of Environm ntal 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
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