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HomeMy WebLinkAboutSWG2023-00115 - SWG As-Built - 1/8/2025 RECORD DRAWING (ASSUILT) pg. 1 MASON COUNTY PUBLIC HEALTH i/ PARCEL IDENTIFICATION Permit Number SWG 1d�3- OOHS Assessor ParcelN Applicant Name M of is Putt _ Subdivision(Name/Div/Block/Lot) Applicant Address 74 D S9 tk` IJe BW City, Slate,zip f- 111, 9854- Installer Name 5 a ob a aa)L Desig ner ner Name Site Address I6NO M s n [4 L� 9 INSTALLATION CHECKLIST �] Full System Installation ❑ Septic Tank Only ❑ Dramfield Only ❑ Repair System Type en1 Type >5 ft.from foundation? -_____-__ B _ _ ❑WA ®YES NO >50 ft.from wells? ----__-__-_ ❑ © ❑ Y >50 ft.from surface wateR ------ ❑ ® ❑ Z ❑ HLleenoul between Dorking end tank? - --- - -- I� p Tank baffles present? ----- ---- 1- 24'access nsem over each comps -- ® ❑ W Effluent filler installed?--------------- --- ❑ n Septic tank srza ) 200 oat Manufacturer T F'1}cwLof o D-box water level and speed levelers used? -------------- - ❑We ❑YES ® NO OJ LL Manfold/D-box accessible from Surface?---------------- - ❑ mZ Check valves installed? ----------------- ❑ ® ❑ oa L1$" SchedulerCk= Sf NNo Transport Line Size Bedrooms installed(check one) ❑2 ❑3 1@4 ❑5 ❑8 soft.from foundation?--------- ----- ❑ Wa ® rE5 ❑ xo >700 ft.fromwells?----------------------------- ❑ ® ❑ -� >100 ft.from surfacewater?----------------------- - ❑ ® ❑ W Il >10 ilfrom potable water llpee?------------"---"---' ❑ 11 QZ >5ft.from property lines and easements?---------------- ❑ ® ❑ K >30ft.from downgradeent curtain/foundation drain?---------- ❑ ® ❑ G DrainOeld level and observation Pons present -------------- ❑ ® ❑ ❑ Grevelesschambers or ❑ Clean gravel used? (Ohackops) 11/p, Proper cover installed Over drainfield?------------------- ❑ ❑ Pump lank setbacks consistent with septic tank?------------- - ❑ WA ® YES ❑ No Y Pump lank size I Zoo at Manufacturer UC'1K �- c Z 24'access riser(s)and accessible from surface?------------- ❑ ® ❑ a ~a Alarm or Control Panel lnslelled7 ------------^---"' - ❑ ® ❑ f Control Panel equipped with Timer I ETM/Counter----------- ❑ ® •❑ 7 LL Pump installed in ❑ Bucks( or ® On Bock or ❑ Other Pump MakelModel K -20ko/Orcnf2 ® Floats or ❑ Transducer y Tank draw down Wmin Pump capecity 16.9 pm Squirt Height ft Pump on time S ci m1 a Pump oft time_2_bk,.L, Deily flow set al HgO gpm RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING f-T ® o 6 VIALVJN mandold Add onenueon G 6 byan OCIµJq BfMwlf[I ® T.'runne0 Pdrksipr LyT.ev.1§: 1'S mmcal din orssed p.fhs 21' ...do. d.atsrwea DaYN.', 11•, aINIn mwvl Se.k.a4wn'.1\� ® SelWvpump bN, plannow b�HAN„Me,.� � Lpcatipn of v .. es n,drona. Preened A 6e0.N R45 ear Ore,Zauoo apg a clea baneN lwa4pm N.r♦� ® Location of aril: r 1m."t suna<n aateca ,w.avle road. © T L U I brs to bed nallva sod between venches Norm a,oa If the designer or Installer feel the need for additional Iofo,malionlcommenb.It may be attached. Peened drawing may also be on o seperate page attached. No.Pages Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER I certify that I installed the system in accordance with I Calli/y that the system has been installed in some, the septic design Stamped'APPROVED'by Mason dance with the septic design stamped"APPROVED'by County Public Health and that any deviations shown Meson County Public Health and that any deviations here have been cleared/appmved by both the designer shown here have been cleareW.Ptuovetl by both and Mason County Public Health and meet all State myself and Meson County Public Health and meal all and Mason County Codes. State and Mason County Codes I further cerfely that ell information contained on(his I further certify(hat all information contained on this long and attached Record raving is accumfe. forth and attached Record Drawing is acounm. 1It 31(Zo24 Sf afun of Installer Date / ar`s l2/3l/..Y J,l 1.G1) s Pnnted Name of Sfgnee �'.,,^',•,.; _ 2 MASON COUNTY PUBLIC HEALTH J s The undersigned approves this Insfallafbn Report and Record DrawmgonbehalfofMason County Pubbe Q.', ADANI J_HUNTER Health CC ^^n l.lr!'kSL'J ISKSIf.NKk Agnalure or Enmmnmenlal Health Spicolat Win (designer s blimp, signature and date) THIS FORM MAY BE SCANNEDAND AVALA&E FOR PUBLIC VIEW ON THE MASON CC)UNTY WEB SITE as 3>iV"1 Nosvw in I i I I I I I 4 I I I I I / I / / F 0 o N / I IIZ I I I I I 1 I I 1 1 0 c y 4 BERM RE 0 r ME / 'a # z O A v o g 4 \ a 9 O m \ C q Y D D X m D c N y y D H 00 N f � 0) Cg \ F ® q0 � TZ 8 x m < z > 90 g Ncn v pm : v O lysr m mo oacl -.Sr/nT 'i o ' m