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HomeMy WebLinkAboutSWG2024-00234 - SWG As-Built - 3/7/2025 RECORD DRAINING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWO 26 O'Z 3ti Assessor Parcel# � ( It 0 ( - SP-r10(Z I Applicant Name B t 1 ( $/1�L4O Subdivision (Name/Div/BIo/�k/Lot) Applicant Address PA t t /_ ) nj,.;d L �j vac L, &/0 City,State,Zip L Y— U Installer Name �- (1 ` Site Address Designer Name TW INSTALLATION CHECKLIST IaJ Full System Installation ❑ Septic Tank Only ❑ Dreinfield Only ❑ RepFSystem Type Pretreatment Type >5 ft,from foundation? _ _ _ _ _ _ _ _ ________----- _ ---- ❑My 1�r7�'.yp ❑ >50ft.from wells? --- -- -- -- -- ------------------- ❑ F ❑ >50 ft,from surface water? --- --------------------- ❑ Z ❑ r Cleanout between building and tank? ------------------- ❑ e ❑ ip Tank baffles present? -- --- - --------------------- ❑ Jx ❑ E24'access dsers over each compartment?--------------- - ❑ 8 ❑ rW Effluent filter installed?--------------- ------------- El ❑ Septic tank size I L 00 tat Manufalbrw D-box water level and speed levelers used? -------------- - Off WA ❑vu ❑ no O0 Manifold/D-bo accessible from surface?---------------- -- ❑ ❑ 00Z Check valves installed? - --- ---------------------- 4:r ❑ ❑ oa S Transport Line Size f " Sd"WUI&YeM 41111 Bedrooms installed(check ore) ❑2 83 ❑4 ❑5 ❑S >10 ft.from foundation?-- ------------------------ ❑WA 401'811, ❑ aO >100f.from wells?- - - -------------------------- ❑ B' ❑ -� >100R from surface water? ----------------------- - ❑ ET ❑ ti >10R from potable water lines?--- ------------------ - ❑ .9 ❑ QZ >5ft.from property lines and easements?- --------------- ❑ AT ❑ K >30ft.from downgradairl curtam/foundation drelM?--------- - ❑ .Q ❑ OrainReld level and observation ports present - --------- 4 Er ❑ ❑ Greveless chambers or ❑ Clean gravel used? (check one) S.•.r"� Proper cover installed over drainfield?------------------- ❑ $ ❑ Pump tank setbacks consistent wkh septic tank?------------ - ❑ WA ❑ Yes, ❑ ao Y Pump tank size I2.di9 gal Manufacturer 4f , 2 ❑ ❑ ❑ 24"access nser(s)antl accessible from surface? ------------ a Alarm or Control Panel installed? --- ----- - ----------- - ❑ {] ❑ 2 Control Panel equipped with Timer ETM/Counter---------- - ❑ 4a ❑ d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 0SC-r lG-`T- a Pump Make/Model nv unnnNAi n annpm NFloatu or ❑Transducer f y Tank drew down PFR OSCAR in/min Pump capecily wpm Squirt Height_ _ft Pump on time 3aSE.0 Pump of time Daily flow set at 2fj Opm lone 1m 14 RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING andoid D a �ndd odomeam &layout Tnnm d dlnnnsuns and oftcal d Manes Will,leyuut Sepbdpump tank pkoaawnt Lorinon or WlMingi Observation pone 8 nlaen-out motions p Leplba mx211S, suffaoe water.& Wide Uadat~native .,]paMeen Toni Nonh Anvrr If the designer or Installer feel the need for additional irdormaBrnlmmments,it may be stlachec! ,J Race Id drawing may also Da on a separate page attached. No.Pages Aaached 1— CERTIFICATION OF INSTALLATION INSTALLER DESIGNER /certify that I installed the system in accordance with I certify that the system has been installed in aceor- 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/appoemp by both the designer shown here have been cleared/epproved by both and Mason County Public Health and meet aft Stale myself and Mason County Public Health and meet all and Mason County Codes. State and Meson County Codes I further certify that all information contained an this I further certify that all information contained an this lam anddaat/Owhetl ecord Drawing is accurate. form and attached Record Drawing is accurate. Signature of Missile, Date &'L%� r 3/4/25 Printed Name of Signee A . MASON COUNTY PUBLIC HEALTH ' The undersigned approves this Installation Report and ty Pu O ' Re Drawing on behalf of '(y'pun h4� � RecordMasod r - He C001, � tu %u 26 ¢ ign C (/L ry o I nor_: FrV(�j 1S eture ofEnvar hmantef tth Hes Spenlatier Date 4 W, Iq (designer's stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAIIABLE FOR PUB61k*KW ON THE MASON COUNTY WEB SI IE Wasp vnrm�a f CL . c ~ � / - - / . � � ) ! \ �