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Home My WebLink AboutSWG2003-00539 - SWG As-Built - 8/18/2004 T` 4 AS-BUILT FORM 3e,V RushedRahrunr 18,1998 Lowh ... Applicant e, . Assessor's Permit Number �(�l//��3 parcel# r�134 goal "'•"— C`v1�S�g Rw'ow_o1U'lph Number) Installer Subdivision 1 (Name/nwNloNeboWlgt) Designer CVO U C P 1y f s I. SEPTIC TANK NIA Yes Prior to Completion A) >3 ft.From foundation?... . . . ..................................... ............ — B) >50Bldg from wens and surface,,,water?u _ C) Bldg eub-om to septic ? . clam.out if not 1.2Y.? B) Bailin intact and clean? .... . . . ............................... X Dividing well dated?access? ...... .. .. . . .............................. Riots installed for access? . ............. .... .. .............. �— —_— G) Tank Siu: 'ann gel;Mmufaauro �2S It. D-Box A) Leveled with water? .. .. ...................................... B) Speed leveler used? .. ........................................ -/C -- III. DRAINFIELD A) >10 It from foundation and>5 ft from property lines? ............... B) >100 ft from wells and surface water? ... ..... .................... -- Q >I0 ft from potable water lines? ......... .. ..................... X -- -- D) Laterals level to±1 inch&end caps present if not looped? ........... Y _ _ �- B) Gravelless chambers utilized? s n ................. -- Fj System dimensions the same as shown .. ....sig on the design?................ O) Grevel clean,properly sized,and proper depth? .................... B) Paeasum S"Mus 1) Sind quality ASTM C-33? .................. ............... 2) Head height uniform and z24 inches? Actual had height_... x 3) Clem-outs and observation ports present? ...................... k- 4) Mowd: Side Slopc 3:17 .. 5) Owner informed electrical connections most be merle by owner or licensed electrician and inspected by L&h? ............. _— IV. PUMP/PUMP AMBER A) Pump erke� Pump model JrG1� i 0 B) Chamber size gal; Mmufacmre 17` -fL _ C) Height of pump off bottom of pump chamber («inches — �— D) Pump chamber draw-down gallons per inch E) Pump capacity 46 4+ 3009 gallons per minute F) Pump contra imer(o )Elapsed Time Meta (circle If Installed) If timer is Do PumpOff G) Screen basket effluent f ucle one)handled? ................ H) Riser hustalled for R. ...... ............................. —_ LHrCKLWr ❑ DrnmSeld&manifold orientation &layout ❑ TrencWbed dimensions and critical distances within layout ❑ Septic/pump tank placement. ❑ Location of buildings. �jl�//J/�✓ 1�1�\\��114)� Cl Observation port ffi clean- out location. T� ❑ Location of wells& roads ❑ Undisturbed native sod between breaches. ❑ North arrow CAUTION:aamr diem b cpac mk location and dr Id orkalpion made to ar field by We batdim an/mWyacoepyplab pghlhd� dM�or deal<oa. the IowWac�o mv�mm(s Wa WbWtY oflhe aYa� ahthe iovullda bWWnPlormabo RPmaal aom.%'etac sMwn abwa i®wr before m+tla4 a%dniRwaaBwo IDe OOIgv IWta@m the ay'eoem WIIVy 4Avydwt2 fi.the apPavod draiga am le s7"i7 wa7 .,,..._ :'Z . ro'.,. d Inafa�llerr "Cheek a box from Row A'and"B",sign and date the certification A. ivy certify that 1 installed the system without my ❑ I certify that all deviations from the design stamped deviation MCDHS from the design stamped"APPROVED" A by Ovm"by MCDHS are showy above. B. ❑ I certify that I contacted the designer and left the >91 I did not contact the desiggnoer prior to final cover because the system open for inspection up to 48 his;prim to designer waived the notification requirement. cover. I further certify that all information contained on this form is accurate. I understand that if the igt'mme n contained herein is not accurate,there will be just cause for immediate suspension of my installercertifr lion. . lgartmn er Dam �O 1 The undersigned approves this installation on behalf of Mason County t of Hem 'cos. anan 1 • ��1Goryoh , • Y1eu 'y6�� IIOV SL vlTti .� V \ PRD�o 6ED /i7,,t L' � ��.. •\ �0 ..d 1 PAP Sits s' IC{ILL-. y0' �y C ypLY eDL �pD`PMDCL O, � �OrGoen30� C A TE 57 .HOLE :. N ON Ad - 2i' Co-weui0D TILL MIELL ay' C.EML-+A.D LLL rl� 0"- 3o SL gip^ Cl' MFI.1E011LL • PLOT PLAN s CIWNE9: ALAW P.. STRD.AICE ' PARCEL !F 3. 1(3L! 7T 9021co 3 - go n..c ro nnrac EXPIRES