HomeMy WebLinkAboutSWG2023-00451 - SWG As-Built - 1/2/2025 'RECORD DRAWING(ASBUILT(pg.1 MASON COUNTY PUBLIC HEALTH !
" PAROEL IDENi1flCATION
PerrnIt Nwiw S1NO ZO L;- OQys _ Ayyesso�Parcel# 27 rf 47 7 M ?r�
Applicant Noma Subdmislon(Name1Dlv/8bd4Lot)
Ap - -wtAddrass
City,slate.Zw Installer Name HZF
Site Address -u-30Designer Name m {f„n- 0-
INSTALLATION CHECKLIST
1I Ful SyYem Mh4aon ❑Tank(s)G* ❑Dr .ftW Ck* ❑e^Pelr ❑(wua
Sys Tme 62= Type
13—
i >50 R irorru wa6s7 - I'Il(�1II,I�,JIIIL(1/III
-.aR from surface water? -
Fa CleaucrdbeMaanbkdldhg and tan DEC 30 0 4
U Tank battles pawl .
El u artesa dsera overaecn canpa ❑ IJ ❑
� Fmrantrom.Irwao.a7- ❑ C� ❑
Segbmdksb. 7Z0(] eat Su✓>l� P/ ,/�
g D- ,ualerleva and ei a leveler used? -
OLL M-doc!O-bm a�sRls from..dare?- O�
22 0mckvaNeshsteaed?- = °❑
Se °
Transport Una,size 2- " SdedulelGass Y
BeO s �� (check e one) ❑2 ❑3 IDq ❑e ❑Commerdav011Dprr
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O >100Rfromwaae?. - o r/ 13 i
>1oo Rfmmeuferew w? 4Wd%
_ >10 R bons potable wateres 6r7• - a
>5 R horn Properly anes and easemenm7- ❑ ❑
G >30 R fran dowrgrediartt suet drains?- ❑
OralMkltl Ievd end obsavatlm present- - ❑ ❑
❑ Grndasschamben or Cleangmvalused? (dunk ore)
PropamyerkstaAedovadm1nMd?- - ❑ ❑
Purnp le^k mftcks con letem with"Po
e tank?- - ❑ ww ra ❑ no i
=Y Parp tank atce ISo1) eel Manufadumr- h fay/
r 24-scoees fleer(e)me acce"ble from surfem7- . ❑ ❑
y Al..or Corrtrul Pend Installed?- . ❑ r� O
Conbol Panel equipped wkh Timer/EJTM Counter- - ❑
_IL Pimp Installed In ❑ Bucket or IN On Block er ❑ Other
S Make/Model Zp�/'A�
� Pt►nP ' Floats or ❑Tnnstluwr
S Tank drew down 4� rNmin Pump mPadty I P 0 oom SgUkl Halghl S g
Ptanp on*no n,.m Pump off dme DaM llm ut at 0 0
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1 o ACPH RECORD DRAWING(ASBUILT)pg.2 Aveessar Parcel N Z Z0'$2 Z 00
/ RECORD DRAWING
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CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
I e&*ffiat Installed the system 0 accordance wflh I cordly Brat the system has been brstaped h aocor-
Mesepdedeslgn stamped APPROVED'by Mason dance with the septic design stamped'APPROVED•by
County Pubra;Health end that any daNadons shown Mason County Publk Health and Nat any dsvW=
ham have been dosmdlkppmved by both Me desIgner sham here hove been c,4am"pproved by bob)
and Mason ComfyPubtb Heath and meet ell Stem mysedand Mason County Pub/k Health and meet all
end Meson Comfy Codes. State and Mason County Codes
I ludhercerdy Nat ail InImmedon contained on this I further cadBy Nat aN lnlomwflon contebred on this
farm and of em Drewrng Is accurate. lone and attached Record Drawing Is accurate.
, g124
Oa Date
flora Msrond
MASON COUNTY PUBLIC HEALTH ' AI
ZC.
77»undamrgnedappmvbe this/nsleMadon PopoffendRetard DmWng on behagof Meson Canty PublicHMph; PJ J HUNTER
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Slgrehae d 1 Haaldr Spoch t Deta (designer's stamp,slonature and data)
THIS FORM MAYBE SCANNEOANDAVAIABLE FOR PUBUCMEWONTNE MASDN C NiYWEB SRE rrewrmn
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