The URL can be used to link to this page

Home My WebLink AboutSWG2022-00635 - SWG As-Built - 10/10/2024 IMUCE5 OCT 0 3 2024 - RECORD DRAWING (ASBUILT) pg. 1 MASON CO b PUBLIC HEALTH PARCEL IDENTIFICATION. Permit Number SVJG 20L'L-W&-A ' Assessor Parcel# Applicant Name _ �j/// p4l GTIhU1 L Subdivision (Name/DivBlock(Lot) Applicant Address cFtU,vSLt:. r.V G 5 Slia�s'r:�6sAi L+ ZrDAnD r City, State, Zip Y�/��)1llrZf &4�f,37S Installer Name u L Site Address 32/ $^5i /r6A/DI;xU Dt, Designer Name kw111 AN_ IfLIATI Full System in [ISeptic Tank Only ❑ Dralnfield Onty t❑��-R"e.�npair F/�F System Type s lation retreatment Type nrv� >5ft from foundation? ---------------- --- -------- ®NIA ❑vss ❑ NU >50R from wells? --------- ----------------- ---- ❑ IN ❑ :z >50 it from surface water? ___________ ______ __ - ❑ ® ❑ Cleenout between building and tank? -------- -- -- - ® ❑ ❑ Tank baffles present? ------------------ ------- -- ❑ ❑ a.:" 24°access deers over each compartment?---------------- El ® ❑ U.1 Effluent fitter installed?.-------------------------- ❑ ❑ !Septic tank size lOyy gal Manufacturer -r L TQ-dT02 /o(a0 ,D-box water leve!pnd speed levelers used? ---- ------- © WA ❑vas ❑ No W :ManlPold/D-box accessible from surface?-_______ _______- ❑ ❑ CPM,Check valves installed? --------------------- ----- ❑ q4 Transport Line Size Schedule/Claw ' Bedrooms installed(check one) f.2 [1 3 ❑4 ❑5 ❑S . . . ,>10ft.from foundation?------------------------- ® WA ❑ YES ❑ No >100ft from wells?----------------------------- ❑ ❑ >100 ft.from surface"ter?------------ ------- ----- ❑ ® ❑ :J�y + >10 ft. from potable water lines?----- ----------------- ® ❑ ❑ 'Z >5 ft from property lines and easements?----------- - E] ® ❑ >30 it.from downgradlent curtainlfounda0on drains?-- ---- ❑ ❑ ,z7 Drainfield level and observation ports present -------------- ❑ ® ❑ I,Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?---- - ---------- ---- ❑ ❑ Pump tank setbacks consistant with septic tank?---- --------- ❑ NIA YES ❑ No Pump tank size /0 4 sal Manufacturer /R.l6r/ty 7a✓ '24°access riser(s)and accessible from surface?------------- ❑ ® ❑ Alamr or Control Panel Installed? ---- -- --------------- ❑ �, ❑ Control Panel equipped with Timer I ETM I Counter----------- ❑ )$ ❑ IL Pump Installed in ❑ Bucket or ®,On Block or ❑ Other :Pump MakelModel 7 0e-ll A.0 k/z N.2 ELFtoats or ❑Transducer 'a-.:..Tank draw down 1*l in/min Pump capacity f.,p gpm Squirt Height 311D '' ft 'RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAINING ommaams mrainfe I 1(JT Sy� Q adentatbn a layout ❑ Trendubed dimensions rile ce \Jcri — �� ate, /� n within ayout a n W r� within layout o - �Q t � • \ ' Sepadpump talc plaosment Lastbn of 4c 3r buldings ❑ Observation ports a 3 ge.,gVD PYa�faS� dear-out locations v. 01 VAir ❑ LocationorwaAe, IVa PA*V bNSri-t` surface water,a made 1fftf'1I �TeSo�� ❑ U dbturbad natbe r vi,( IrN + .S2CN . sail between la p 1.\2 0 A SJJ herwhea North Arrow If the designer or installer I the need for additional hdormatlon/comments,If may be attached. Record drawing may also be on a separate page attached. No.Pages Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER I certify that I installed the system in accordance with 1 cedi/y Ill aI the system has been installed in accor- Me septic design stamped'APPROVED"by Mason dance with the septic design stamped'APPRO VED'by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been clearodfapproved 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 informed comainedonthis IFJrther certlfythet all Information contained on this form and a shad Rea ing is accurate. form and atfacheW Record n i rate. �.tr�z�f� 2o2Y I[ Signature of Installer Date s FfL-L- ff CVL/Kn -L G Printed Name o/Sigrree MASON COUNTY PUBLIC HEALTH y\� SlW273 FT The undersigned approves this Installation Report and 2. }AMPS A.HUNTER Record Drawing DESKAJERrd Drawing on behalf o(Mason County Public - �Z1z�T5 Health: e<FTFS 011221'f� cny) (dIIJ�L`1 Signature of Environmental Hesith Specialist Date (designer's stamp,signature and date) li . p . . . . . . . . ...y , � �.....�� § D � . $ « � m } ol . ; . \ - » / dj /] \ ' . � � . . . . . .