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HomeMy WebLinkAboutSWG2024-00040 - SWG As-Built - 1/14/2025 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG QoZ4 - ODD`i O Assessor Parcel# 1�-o d O'IVIO cyl Applicant Name %46 S y"4 Subdivision (Name/Div/Block/Lot) Applicant Address a` Iv 0- City, State, Zip %A Ovc" .v1N %&I _ Installer Name sf 9'04,as Site Address 40E (.AU.wh C vc �r Designer Name S-m. Nujv „;c. A%a"ta INSTALLATION CHECKLIST EM Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair System Type " ' Pretreatment Type ,,....(( >5 ft. from foundation? --------------------------- ❑NIA Lrr.J.tt YES ❑ NO >50ft.from wells? ----------------------------- ❑ CJ ❑ Z >50ft.from surface water? ------------------------ ❑ ,,,..©,,,((( ❑ F Cleanout between building and tank? •-----------------• ❑ ❑ V Tank baffles present? --- ------------------------ ❑ ❑ A24"access risers over each compartment?---------------- ❑ ❑ W Effluent filter installed?- -------------------------- ❑ ❑ N Septic tank size I1SO cal Manufacturer W w gw&k o D-box water level and speed levelers used? --------------- ❑NA gym ❑ No DOLL Manifold/D-box accessible from surface?----------------- E ❑ fe= Check valves installed? ------------------------- ❑ ❑ o< ° E Transport Line Size N Schedule/Class SOk a> Bedrooms installed(check one) ❑2 53 ❑4 ❑5 ❑6 >10 ft. fromfoundation?-------------------------- ❑ NIA h� f y" 7. Q >100 ft. from wells?----------------------------- ❑ j W >too ft.from surface wateR •----------------------- ❑ r LL >10ft.from potable water lines?---------------------- ❑ r QZ >5ft.from property lines and easements?---------------- ❑ K >30 ft.from downgradlent curtain/foundation drain?---------• ❑ esr G D infield level and observation ports present -------------- ❑ C.I h Gravedess chambers or ❑ Clean gravel used? (Check one) ca Proper cover installed over drainfield?----------------- ❑ EF Pump tank setbacks consistam with septic tank?------------- MEVA ❑ Iles El NO ZPump tank size gal Manufacturer 24-access riser(s)and accessible from Surface?------------- ❑ ❑ ElA Alarm or Control Panel Installed? --------------------- ❑ ❑ ❑ IL 2 Control Panel equipped with Timer I ETM/Counter----------- ❑ ❑ ❑ R Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 6 Pump Make/Model ❑Floats or ❑Transducer a Tank draw down in/min Pump capacity apm Squirt Height ft Pump on time Pump off time Daily flow set at apm r.:aalmrm�a RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING Drainfald& manifold orientation &layout Trenenafed dimensions and crincal distances within layout Sepgrlpump tank placement Location of buildings Obeervallon Pads& dean-out locations Location avtolls, swlace"tar.& roads Undisturbed native soil between benches NOMAITOW If the designer or installer feel the need for additional InformatioNcomments,it may be adached. I Record drawing may also be on a seperate page attached. No.Pages Attached CERTIFICATION OF INSTALLATION ' INSTALLER DESIGNER 1 certify that 1 installed the system in acO0fd nce with 1 certify 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 cleareWapprov id by both Me designer shown here have been cleamolapproved by both end 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 1 further certify Mat all information Contained on this I further certify that all inlomnab'on contained on this ram amd rd Drawing is eocumts. form and attached R rawing is accurate. signs � ter7I Data y �S✓� f 111 f/S ...'.0..,.,.�; Printed Name of Sig'ae MASON COUNTY PUBLIC HEALTH a _ l ~• si The undersigned approves this Installation Report and s,oai2 ' Y ADAM J.HUNTER Record Drawing on behalf of Mason County Public 't'iCKRSI!b'rif:SiiNE'A"` Hea�lth�:�(1/��'''�y�p�/—\'�}�M� Signature of Environmental Health SPeclalist Date (designer's stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC NEW ON THE MASON COUNTY WEB SITE ry vmo+a . - Al Nut :, 2 ) ` i � � -- - : � ) \ | � ! ( » ° � \ \ \ , n � - - - - - - - - - _WUM_«_S - - - - ) . � CASCARA COVE ` \ 0 , 2 \ \\ 2 § § \ [ ) � 90 \ | , | § \ � ; f ) |