HomeMy WebLinkAboutSWG2017-00311 - SWG As-Built - 12/20/2024 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2a Assessor Parcel#L20041 —�„��.)�
Applicant Name J� o0.,c Subdivision(Name/Div/Block/Lot)
Applicant Address 10YOV J (,o.} I t,J-
City, State, Zip k✓ , Installer Name rA '-r n
Site Address 63
Designer Name , r^
INSTALLATION CHECKLIST
®Full System Installatlon ❑Tank(s Onty/ ❑ Drainreld Only Repair ❑Other
System Type PI'mX-fe �rzneJl Pretaebnent Type
>5ft.from foundation? --------------------------- ❑WA ®YES ❑ No
:.
>50ft.from wells? ------------------------------ ❑ � ❑
_ 150ft.from surface wateo ------------------------ ❑ ® ❑
F Cleanout between building and tank? ------------------- ❑ 1jo ❑
U Tank baffles present? --------------------------- ❑ Is ❑
a24"access risers over each compartment?--------------- ❑ El ❑
W Effluent filter installed? 'w Ater---------------------------- ❑ Ely .r rn7
Septic tank size )s4 '� gef Manufacturer Sor1.j P�MPm.o
D-box water level and speed levelers used? -------------- - ❑WA YES ❑ NO
G0U. Manifold/0-box accessible from surface?---------------- - ❑ No ❑
OQ Check valves installed? ------------------------- ❑ ® ❑
2 Transport Line Size Schedule/Class S h 'y0
Bedrooms installed(check one) 02 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10ft.fromfoundafion?------------ ------------- ❑ WA YES ❑ NO
>100 ft from wells? _____-----___--_-___ ❑ ® ❑
W >100ft.fromsurfacewate ?-_______________________ ❑ ❑
LL >10ft.from potable water lines?--------------------- - ❑ ❑
Z >5 ft from property ❑ �' ❑_ p party lines and easemen4?----------------
>30ft.from downgradient curtainRoundation drains?---------- ❑ Io ❑
Dminfield level and observation ports present -------------- ❑ IR ❑
Q Greveless chambers or W Clean gravel used? (check one)
Proper cover installed over dminfield?------------------- ❑ Ja ❑
Pump tank setbacks consistant with septic tank?------------
. I n El No
Pumpiankslze 0-3 al Manufacturer:
Y uJn 5
F. 24°access riser(s)and accessible from surface?-----------tom ❑ M ❑
a Alarm or Control Panel Installed? ----------- - ❑ ® ❑
? Control Panel equipped with Timer/ETM/Counter----------- ❑ ❑
a Pump installed in ❑ Bucket or IT On Block or ❑ Other
M pump Ma dal W �a n Z pni s s or ❑Transducer
n Tank tlraw tlown M, INmin Pump cepecity Pm squirt Heigh[ a-! n
Pump on time bra Pump otf tlme Dally flaw set at�� . npd
vsmee,rmm.s
jim- 2020
oV
I MLTN RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel#
RECORD DRAWING
orieP Drentation&tH&manrfut
w/tloeatio . for
relocation.
TrancNbt
dimensions and
ih tance s
within layout I
AV k
plaownent tank My P�� -
placement 1 � x^1
Location Pfbuildings f' -L
existing/goPaiul
Observation Ports, •'V'1�ILIr' '"-_ ,
daenout locations,
&menifdds/d-boxes
yJ uurfaw orwalls roads,
s craw water,castle,
a watatlme, v q✓' Wes<OF.
Reserve aroa(s)
�North Armw /lU
If the designer or installer feel the need for additional informationicamments,it may be attached.
Record dawing may also be on a separate page attached. No.Pages Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
I Calffy that I installed the system in accordance with I Certify that the system has been installed in Scour-
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 I further cerfify that all information contained on this
form and attached Record Drawing is accurate. to=and attached Record Drawing Is accurate.
fie'. +'11." 1— ,31- I1
SlgnaNr✓rw Astaller Data
Pd„rea Nama Mslgnea
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
,I^u
Health: ti siPoa¢ vF
p: ADAI,I J.HUNTER
�rwy���yr1 IZf��� r_rl ��ISSI�PsieN�a. .
signature ofEnvimnmente/HeeRh Specialist Date (des/gner's stamp,signature and date)
THIS FORM MAYBE SCANNEDANDAVAILABLE FOR PUBLIC VIEW ON THE MASON OOIINTYWES SITE Uoa•wel.'
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