HomeMy WebLinkAboutSWG2024-00472 - SWG As-Built - 1/14/2025 RECORD DRAWING(ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDEN71FICATION
Permit Number SWG 2624 -ony`72 Assessor Parcel a '6435S 1OL 30
Applicant Name r �(m(b,(Subdivision (Name/Div/Block/Lot)
Applicant Address L415 t 4 It
City,State,Zip Installer Name d: \�1 d,,
Site Address -EG� CIOL Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ® Repair
System Type Sw� 11•-tO 3a Pretreatment Type !!!
>5ft.from foundation? --------------------------- ❑WA Ives NO
>50 ft.from wells? ----------------------------- ❑ 18 ❑
_ >50ft.from surface water? ------------------------ ❑ Fel ❑
H Cleanout between building and tank? ------------------- ❑ ❑
V Tank baffies present? --------------------------- ❑ ® ❑
a24"access risers over each compartment?---------------- ❑ f2� ❑
W Effluent fitter installed?--------------------------- ❑ ❑
M
Septic tank size--UP gal Manufacturer IkPNLh�
O D-box water level and speed levelers used? --------------- lnWA ❑vas ❑ No
�O ManifoW/D-hox accessible from surface?----------------- ❑ ❑
LL
10 Check valves installed? -------------------------- ❑ ❑
OCc
f Transport Line Size IV Schedulef0ass 40
Bedrooms installed(check one) ❑2 ❑3 04 ❑5 ❑6
>10 ft.from foundation?-------------------------- ❑WA dyes NO
0 >100 ft.from wells?----------------------------- ❑ ® ❑
W >100 ft.from surface water?------------------------ ❑ ❑
li >10ft.from potable water lines?---------------------- ❑ ® ❑
aZ >5ft. from property lines and easements?---------------- ❑ 0 ❑
C >30 ft.from downgradient curtain/foundation drain?---------- IN ❑ ❑
Drainfield level and observation ports present ------ ❑ 8 ❑
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfeld?------------------- ❑ ® ❑co
Pump tank setbacks consistent with septic tank?------------- ❑ wA 9Ves ❑!� j1'I
X Pumptanksize .70° aal Manufacturer
r
Q24'access dser(s)and accessible from sudace?------------- ❑ ® ❑� b
aAlan or Control Panel Installed? --------------------- ❑ ❑(
= Control Panel equipped with Tmer/ETM/Counter----------- ❑ ❑�
6 Pump installed in ❑ Bucket or Q On Block or ❑ Other
IL Pump Make/Model (~;t vl--1 LEVI, 5?Fbats or ❑Transducer
M M
y Tanktlawtlown > 7S iNmin Pumpcepactty CPO apm Squirt Height ka ft
Pump on time I re+� Pump off time 4 W"'n Daily flow set at,.jW apm
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DI AVANG
Dralntield 8 —
manifold oiieMaton ,
&layout
TlencNCed Ol
dimensions,and
critical distances X
wehin lay.N
Septiclpumpunk j
piacemera
Location of Oo
Euldlres
Observe I"te ,
naaton wrts
oka
Location ofwells,
surface water,8
roads
Undisturbed native
soil between
bmrhes
NoMA=w
If the designer or installer feel the need for additional informatioNcomments,it may be attached.
Record drawing may also be on a separate page attached. No.Pages Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
I cerfiy that I installed the system in accordance faith I cem'ty 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 cleareaVapproued by both the designer shown here have been clearedtapproved 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 Cal iy that all information contained on this I further cer iy that all information contained on this
form$qd as h ed Record Drawing is accurate, form and attached Record Drawing is accurate.
4l/ ;1--/C���i/ f - G- 2�
Signature of Installer Date
Pnntetl�o�gn ee) y �/
MASON COUNTY PUBLIC HEALTH ^
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health.'
Signature of Environmental Health Specialist Date (designer's stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
{
c
a
p rn 9 H
,..-
N
m
OQ
tA
3a
m m N OrpLn
N
N
w a 0
V1
S