HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 1/28/2025 ECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 1982 Assessor Parcel # 323095400001
Applicant Name JIM BLUM Subdivision (Name/Div/Block/Lot)
Applicant Address COLONY SURF 5 LOT 1
City, State, Zip Installer Name B&J CONSTRUCTION
Site Address LONY SURF DR Designer Name ADAM HUNTER
INSTALLATION CHECKLIST
❑✓ Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type GRAVITY(1982) eatment Type WA
>5 ft. from foundation? -- - - -- -- - - -- ❑ NIA ❑✓ YES NO
>50 ft.from wells? -- - - -- -- --- - -- - ❑ ❑✓ ❑
z >50 ft.from surface water? -- - - -- jAN 2 1 2M25__ ❑ El
FCleanout between building and tank? ----- - - ❑✓ ❑ El
U Tank baffles present? - - ---- - - - BY - ❑ ❑✓ ❑
a24"access risers over each compartment?-- ----- -- -- -- -- - ❑ ❑
W Effluent filter installed?-- - - - -- -- - - - --- ---- -- - -- -- - J❑ ❑ ❑
N
• Septic tank size 1200 at Manufacturer LOCAL
0 D-box water level and speed levelers used? -- - - -- -- --- ---- ❑d WA ❑ YES ❑ No
�O Manifold/D-box accessible from surface?--- - - - -- -- - -- --- - ❑ El
mZ Check valves installed? - - -- - - - -- - --- - --- - - -- - --- - ❑✓ ❑ ❑
�� Transport Line Size 4" Schedule/Class N/A
Bedrooms installed(check one) 0 2 ❑3 ❑4 ❑5 ❑6
>10ft. from foundation?- --- - - --- - --- - - -- - --- - --- - ❑ NIA ❑✓ Yes ❑ no
93 >100 ft.from wells?-- - - - -- --- --- -- - - - --- --- --- -- ❑ 0 ❑
W >100 ft.from surface water? - --- - --- -- -- - -- -- -- -- --- ❑ ❑� ❑
M >10ft.from potable water lines?--- --- -- -- --- -- -- -- -- - ❑ ❑✓ ❑
Z > 5 ft.from property lines and easements?-- - -- - - --- - --- - -
a: > 30 ft.from downgratlienl curtain/foundation drains?- - - - -- - - - - ❑
Drainfield level and observation ports present -- --- - - - - --- - - ❑ ❑� ❑
❑ Graveless chambers or ❑J Clean gravel used? (check one)
Proper cover installed over drainfield?--- - - - ---- --- - --- -- ❑ ❑� ❑
Pump tank setbacks consistent with septic tank?- - - - - ------ - - ❑✓ NIA ❑ YES ❑ No
Y Pump tank size NIA at Manufacturer N/A _
QH 24"access riser(s)and accessible from surface?--- - -- - ---- -- ❑✓ ❑ El
C Alarm or Control Panel Installed? --- - -- - -- -- - -- ----- -- ❑ ❑
2 Control Panel equipped with Timer/ETM/Counter-- - - - - - - - - - ❑✓ ❑ ❑
M
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
0. Pump Make/Model N/A ❑ Floats or ❑Transducer
S Tank draw down N/A in/min Pump capacity NIA opm Squirt Height N/A ft
Pump on time N/A Pump off time NIA Daily flow set at NIA opm
Boa rmaor4
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
O Dralnfield&
manifold orienlation
&layout
O Trenchlbed
dimensions and
critical distances
within layout
Q Septiclpump tank
placement SEE ATTACHED
O Location of
buildings
O Observation ports&
clear-cut locations
O Location of wells,
sure..water,&
road.
E) Undisturbed native
soil between
trenches
ONorth Amow
If the designer or installer feel the need for additional information/comments,it may be attached.
Record drawing may also be on a separate page attached. No. Pages Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
I certify that I installed the system in accordance with I 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 cleared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Masoq County Codes. State and Mason County Codes
Onatum
ify that all information contained on this 1 further certify that all information contained on this
to Record Drawing is accurate. form and attached Record Drawing is accurate.
1/21/25
a I ONl19 DESIGNER Date
ADAM HUNTER 1/21/25
Printed Name of Signee
nT r
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and .u• :',:;
Record Drawing on behalf of Mason County Public
Health:
SJ7n, Sn n.
Signature of Environmental Health Specialist Dale (designer's stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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