HomeMy WebLinkAboutSWG2014-00138 - SWG As-Built - 8/11/2015 Hpr 01 15 07: 56a Hill MoTurnal Enterprises 1 -360-427-OI68 p. l
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' RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit f,hnber SWG /� y 0 Assessor Parcel#
Applicant NumetX81ug:;9( _K., ("�2ot4w<ts{Subdivislon (Name/Div/BbcklLot)
Applicant Addrew D - 0 -� 2;e .9 . L
City, State,Zip ,�LI„�. Installer Name 64 M�tl AW&C -6s±-
Site Acidness l-rc- = i ,` Designer Name Z;M HkYdfd-
INSTALLATIONCHECKLIST
Full System Installation ❑ Sepgc Tank Only ❑ DrainSekl Only ❑ Repair
System Type L-O,u F�Le-C iS. Pretreatment Type
>5 ft.from foundation? -_________________________. ❑we ®rss NO
>50ft.from wells? ----------------------------- ® ❑ ❑
Y >50 it.from Surface water, ------------------------ ❑ 0 ❑
FClaanout between building and tank? ------------------- ❑ ® ❑
U Tank baffles Present? ---------------------- ❑ ®nn ❑
F 24'acces5 risers over each compamrtenl?---------------- ❑ Sa ❑
NEffluent filter Installed?---- - -- -------------------- ❑ ® ❑I
Septic tank size �0 gel MaMl (p acturer �Q �' ,, (,/)}p+� I h jtCLAMf-
-:S C-box water level and speed levelers used?---------------- ® ❑ ❑ ao
OLL ManifokCbox accessible from surface?------------------ ❑ ® ❑
WZ Check valves installed? ------- - - ---.------------- ❑ ® El
X Sctedule/Cless W
^E Transport Una Sae_ -
Bedregms Installed(check one) ❑ 2 03 ❑4 CIS ❑6
>10 ft.from foundabwn7-_____ ____ _____ _ _________. OW ®.Yes ❑ eo
>100 ft.irom wells?---- -------------------------
❑ ❑
W >100Rfrom surface water?-----------------------. ❑ ❑❑
LL >10ft.from potable water lines7------- --------- ElZ >5 ft from property fines and easements? - -- ---------- ❑ 5' ❑
-30 ft-from dcwngradiara outNn/lcundeeon dre11s7---------- 0 ❑ ❑
Dminfield level and observation pods present -------------- ❑ ❑
® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield4------------------- ❑ ❑
Pump tank setbacks consistent with septic t4Nt7------------- ❑ Wa OYES ❑ NO
Y Pumptanksize /.I- sal Manufacturer /040
a24'access riser(s)and accessible from surface?---------- --- ❑ O Ela Alarm or Control Panel Installed? -------- ------- - ❑ IR ❑
M Control Panel equipped with Timer/ETM/Counter--------- -- ❑
a Pump installed in ❑ Bucket or O On Block or ❑ Oder
a
Pump Make/Model ^-�'�t )g u (� Floats or ❑Trartsducer i.
a Tank draw down 2 kurnn Pump capacdy 40 gpm Squlrf Height
Pump on time )aS M Pump or,time ul N2S Daly How set at CDC)_9pm
OMS
Rpr 01 15 07: 45a Bill MCTurnal Enterprises 1 -360-427-016B p. 2
MASON COUNTY PUSlIc HCALTI-r
t.,,ce O arAwtA1i; 0S8U1LT)p9• Z RECORD DRAWING
0 Ilminaald b
,.wwoa ademero�
a wvwf
TmnchAWJ
dimere, aW
'10ca delanoaa
wif nIayaa
SeplidpumD tank
pao am
Lost On Of
bwldbge
Obsewegon PVRab
cWer,cul lomhord
0 aatla ateWN,
"Ohao,waW..b
made
LagleWraad men.
Boil bebveen
"news
71 NCMAnea
If the designer M Imbee r feel the need for add'Nonal intorinaborlcommenU.A may be attached No pages Anached
Record drawing may also be On a separate page attached.
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
1 certify that 1 installed the system in accordance with I certify that the system has been Installed in action
the septic design smped'APPROVEX by Mason dance with the septic design stamped'APPROVED'by
la
CounlyPubik Health and that any deviations shown Mason County Public Health and that any deviations
here have been Ueared/approved by both the designer shown here have been clearadfapproved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Cedes. State and Mason Court y Codes
I further certify that&V information contained on this
1 further C,ed y,that as Information contained on this
form and ad Chad Record Drawing is accurefe,
to"and attached Record sw G ing le aural
SlgneNre Irrsralbr Data i��
s
12 1r,1
Pn'Ned Name of Signae
MASON COUNTY PUBLIC HEALTH •'.t ,
The undersigned approves this Installation Report and • Is,l,.r l vrtq
Record D2wi n behalf of Mason County Public itr� �11111.l- rp
He I EXPIRES: CWVL6
�o \5
Signetwe Blvi en Haalm Specialist Date (dW016/s stamp.signature and date)
TKS10FtN�MAY6E SCANNED AND AVALABLE FOR PUBLIC VIEWON THE MASON COUNTY WEB SITE
Printed frc_'s l i, ., .. - t:, S
Famed Pont Vason Cmmfy OW, - - -