HomeMy WebLinkAboutSWG2017-00211 - SWG As-Built - 12/20/2024 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 'LOtl-Oot1t Assessor Parcel# 62.0OlAt000'SO
Applicant Name Kw.�l,,,�.�y1a Subdivision (Name/Div/Block/Lot)
Applicant Address 91 W (Yvisr�a4 0.
City, State, Zip 5hr.134ur` WA 44.59A Installer Name 9,.ayd.r.., S�Mc
Site Address (At k &4i-r" (4, Designer Name Tim 41wr%�-
,..,( INSTALLATION CHECKLIST
5 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type 5'• Uovd Pretreatment Type
>5ft.from foundation? --- - -------- - ---- - 9WA ❑YES El No
>50 ft.from wells? --- - - - - - --- - - ------ - -- ❑ ,9 ❑
Z >50ft.from surface water? -- - -- - ---- - - - ----- --- - -- ❑ ,Lv,�( ❑
F Cleanout between building and tank? ---- --------- ------ ❑ LI ❑
O Tank baffles present? - - - -- ------ - -------- ❑ LdJ ❑
1 24"access risers over each ompartment?-- ------- ------- ❑ 19 ❑
Lu Effluent filter installed?---- - - -- ---- ---------- - -- --
❑ ❑
Septic tank size 1200 net Manufacturer -UA
1
OO D-box water level and speed levelers used? - - --- - - - - - - - - -- ❑ NIA ❑YES No
�O Manifold/D-box accessible from surface?--- ----- - - - --- - -- El El
°PZ Check valves installed? - - - -------- - - - --- - - - - - - --- ❑ ❑
OQ
f Transport Line Size ?_
Bedrooms installed(check one) ❑ 2 g ( ' 4 5 ❑B- Commercial/Other
>10ft.from foundation?-- - -------- -- U `i ❑
- -}�,- - ) NIA El Yin No
O >100 ft.from wells?- ---- -------- -- - -- 7�-- i_ L.v.�/ ❑
>100 ft.from surface water?--------- - By-. L_v�,( El
M >10ft.from potable water lines?------ --------- -- ❑ L°I ❑
Z >5ft,from property lines and easements?--- ------------- ❑ ❑
> 30ft.from downgradient curtain/foundation drains?----- - -- -- [if ❑ ❑
Drainfield level and observation pyrts present ---- - - - - - ----- ❑ L� El
❑ Grave less chambers or Clean gravel used? (check one)
Proper over installed over drainfield?--- ---- ------------ ❑ El,,_�(r
Pump tank setbacks onsistant with septic tank?----- El NIA CI YES ❑ No
Y Pump tank size WOO gal Manufacturer µaa�rrr v.n Qrt.-Cask
Q24'access riser(s)and accessible from surface?----- ----- -- ❑ El0.a Alann or Control Panel Installed? ----- --- - ------ ---- -- ❑ El
E Control Panel equipped with Timer/ETM/Counter--------- -- ❑ ❑
7
a Pump installed in ❑ Bucket or [,j(On Block or ❑ Other
Pump Make/Model UbjL) , 1-160 ❑ Floats or [Transducer
a
Tank draw down_, [��iNmin Pump capacity�gpm Squirt Height 2 ft
Pump on time Pump off time Oki Daily flow set at 260 apd
MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel#52Ur,-r4l l]cnalo
RECORD DRAWING
Drainfsld&manifold �« h� 8U rn'V''"r T011
orientation&layout
wldlmenslons for
relocation.
[� Trench/bed •4 pron 'itu f O.r}
dimensiona and 40%0I
critical distances Y 0?
within layout
[^� Sepy1.�/6ugac"9
placement lank
placement
�o
Location of buildings O
existing/proposed ` Q
Obsewagon Ports,
clearroul locations,
&manifoltlsld-boxes
Location of wells, W�`�
surface water,roads, ^1
,..t/ &waterlines. W U.1
Reserve area(s) /
North Arrow z
If the designer or installer feel 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
I certify that I installed the system in accordance with I 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 clearedlapproved by both the designer shown here have been clearedlapproved 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 certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
Ze•
Signa re of Installer Date
12/(- DES SC}}pEYJI
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and 0 �(—�--
Record Drawing on behalf of Mason County Public
Health:
Signature of Environmental Health Specialist Date (designer's stamp, signature and date)
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VIEB SITE uf`sk 1 vrz015
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