The URL can be used to link to this page

Home My WebLink Aboutswg2014-00140 - SWG As-Built - 6/3/2015 (2) RECORD DRAWING(ASBUILT) pg. 7 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG Z. I/ -Oo/ SJo Assessor Parcel# Applicant Name id"A.; mVrvob Subdivision(Name(Div/Block(LOt) Applicant Address 2111 -25 -14"1 hnn Gn. s,= 0- / 85- • Let 9 City, State,Zip cf/ie-JJ++n JrA 9'SSVV - stellar Name L✓iJ/�1 onsi JJc 44c Site Address 7Y1-,F hi, Ge. Designer Name ,/Va's Eesr eo7T INSTALLATION CHECKLIST ull System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair V4,✓. System Type Frmssr =4;1' r�7ie4 Pretreatment Type .6a V SJ2Y -O >5 fl.fromfoundation? --------------------------- ❑ran E�FV6 ❑ NO >50 ft from wells? .---------------------------- ❑ 0� ❑ Y >50ft.from surface water? ------------------------ ❑ 0 - ❑ fCleanout between building and tank? ------------------- ❑ 0' ❑ O Tank baffles present? --------------------------- ❑ R� ❑ 24'access nears over each compartment?---------------- ❑ 11� ❑ W Effluent filter installed?--------------------------- ❑ N Septic lank size cal Manufacturer O D-box water level and speed levelers used? --------------- [J<A We No 0O Manifold/0.box accessible fromsurface?----------------- ❑ 9� ,❑�/ M2 Check valves installed? -------------------------- ❑ ❑ LrS Transport Line Size 1 Schedule/Class -7" Bedrooms instelled,(checls me) ❑2 pf ❑4 ❑5 ❑B >10 ft.from foundation?-------------------------- ❑ WA. 0•ea ❑ No 0 >100 ft, from wells?----------------------------- ❑ D/ ❑ W >100 ft,from surface water?------------------------ ❑ �R- ❑ / rS soft,from potable water lines?--------------------- ❑ LY ❑ >5ft.from property lines and easements?------------- ❑-,/ �� El >30 ft.from downgradient curtainif undabon drains?---------- 2 ❑ ❑ Dralnfisld level and observation ports present------ ❑ [r� ❑ EKmveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ 0—� ❑ Pump tank setbacks consistent with septic tank?------------- _ ❑ NIA 0-9 ❑ No Y Pump tank size /200 at Manufacturer Z -- 4 24'amess riser(s)and aaessiblefrom surface?------------- ❑ ~ Ala"or Control Panel Installed? --------------------- ❑ Q-� ❑ a Control Panel equipped with Tmer/ETM/Counter•---------- ❑ Er- ❑ 7 — d Pump installed in ❑ Bucket or Dy_`` 'cm BbrJr or ❑ Other a Pump Meke/Model .Zsc//e� /77/5'i lOats or ❑Transducer a Tank draw doom 2 intmin Pump eapeclly So apm Squirt Height 2,J- ft Pump on time 7•c/- Pump off time 9�'a Daily flow set at .SO apm ,..e.a sums in County DMS 1 RECORD DRAWING (ASBUILT) pg.2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING xexexd a mtMbk enentadon a layout _. Trendebad dlmamions end aeml dotenms wilnn layout Septopurap tank / geca an Loutlen of If/� buildings ❑ Oeeenellm pats Y7 deencla bcstbos Lecaeon ef.h. wdam waterb roads UMbtubed neNa tat beMean bachas 0 Nartlb n w It the designer or installer keel the need for addNonal lnformaUeNcomments,It m ay be attached. / Record drawing may also be on a separate page aaachad N Pages Attached _ CERTIFICATION OF INSTALLATION INSTALLER DESIGNER I owt/ty Net I Installed the system in accordanw with I cedify that the system has been installed in accor- the septic design stamped'APPROVED'by Mason dance with the sepbb design stamped'APPROVED-by County Public Health and that any deviations shown Mason County public Health and that any deviations here hove been clearediapproved by both the designer shown here have been dearaNapproved by both and Meson County Public Health and meet all State myseHerld Mason County Public Health and meet all and Mason County Codes. State and Mown County Codes I ludhercertify that all mAmradon contained on this I rudnarcerilly that ell Information contained on this form and attached Record Drawing Is accurate. form and attached Reoe d Omenn,is accurate A . Sip t Ina Iler Date 4' / • MARy l!S a lIt 1.1f�M4 Pndai Nameot Sgnee V ? W MASON COUNTY PUBLIC HEALTH O q 8 O ?W The undersigned approves this Installation Report and �9y OyTFV.Ea Record Drawing on behalf of Mason County Public ONA Health/:^ I 1\ll Nd Signature of En nmernal Health Speda bst Data (designer's stamp, signature and date) THIS FORM MAY BE SCANNED MD AVNIABLE FOR PUBLIC VIEW ON THE MASON CCUNTY YIEB SITE mWetmlmtr, Printed from 1riason County fJiv:z . � i � Jt \ x x ; { f2 � i I-* ° ® / � a . | . | .� \ a � -CO Print(: » %a:ar »«<r« 9«» • i,11ATER PR�NTINN 3 LOI � js wr� � 1 E �r S}i cF vte eaf TiM�R -CM -Nne 06bu;�� r uYiQAA AfQ- W t � ro are h D g-L`�e � F2✓vier T5 i�tL e OQ- Lmb oJhk)(Q eav die ,. 7675New Mato St.SW6 maAu'm5o"'at�Pn°fiuB.com „_,..:. 360.943-2204/Fu:360-943-220 /Eil:W@ RECORD DRAWING (ASBUILT) Pi - MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SVM Z0;H - 00/ ND Assessor Parcel# 27 a 10-/3. 9020/ Subdivision NamelDivBlock/Lot) Applicant Name /�. .:� Lf//�.�A ( Applicant Address 2Y/ E Chn.r A;a [n. S.= �/a 85- Lei9 City,State,zip rS/ Z& wA 9efyy taller Name �Ji ons le LGc. Site Address 211-,9 eArv 'i.e Gn. Designer Name G/1Rvs .Ees7covr- INSTALLATION CHECKLIST ull System Installation ❑ Sepik;Tank Only ❑ Drainfield Only ❑ Repair Systam Typa P • n o�u!'t •/F+•c-Tiuf Pretreatment Type —e PoO G�SO -N >5ft.from foundation? --------------------------- DMA Lrei ❑ No >50 ft from wells? ----------------------------. ❑ 0-� ❑ _ >50ft.from surface water?------------------------ ❑ 0! ❑ H Cleanout between building and tank? ------------------- ❑ 19� ❑ (j Tank baffles presem? --------------------------- ❑ [� ❑ 24'acoess risen wet each connPartmeNt?---------------- ❑ ❑� ❑ W Effluent filter installed?---------------------"'--- ❑ ❑� ❑ N Septic lank sae sal manufacturer O D-box water level and speed levelers used? --------------- M116A ❑Yea ❑ No OLLMangolND-box accessible from surlaw?----------------- d6 ❑ ❑� .❑�/ mZ Check valves installed? -_____________ _________- ❑ ❑ (y) Transport Line Size � Schedule/Class 300 P Bedrooms insffiIled,tcheck one) ❑2 2'5 ❑4 ❑5 ❑e swEkY9 ❑ No >10a.from kundation7-_________________________ ❑ _ >100Rfrom wells?---------------------------- ❑ �� ❑ w >100 ft.from Surface water!------------------------ ❑ Q� ❑ ir >tofl.from potable water linos?---------------------- ❑ �[-.�/ ❑ ¢Z >5 ftfrom property lines and easements?------- ❑/ I-- ❑ Q >30 ft,rem downgradiem eurwinHoundation drain?---------- a ❑ O Drslnfield level and observation ports present-------------- ❑ [Kmveiess chambers or ❑ Clean gravel used? (check one) Proper cover installed over dreinfleld?---------------- ❑ E3--- ❑ Pump tank setbacks conalstan t with septic tank?------------- . ❑ WA Ly'Yea ❑ No Z Pump tank ante /2 or. cal Manufacturer ra i Q 24'acoess risers)and accessible from sudace?------------- ❑ 0` ❑ yAlarm or Control Panel Installed?--------------------- ❑ ❑ E Control Panel equipped with Tkner l EThl l Counter---------- ❑ Q� ❑ n. Pump installed in ❑ Bucket or n Block or ❑ Other ..��//'' a Pump Make/Model �'- �w 1V/Si LyPloaffi or ❑Transducer a Tank draw down 1 INmin Pump capacity ,Sd gpm Squirt Haight 1..>' tt Pump on time 2.t Pump oft time B ivs Daily flow Set at--.1-0�gpm core rwmea Printed from 1 RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING D IMaM 8 manatee mano"on 8leyaa Tmer no Ors a na oeacald wave hyW Septlm hnk peumentem I'f� - Obanvenonaans8 tleen-M bcathn. .0.—tec 8 mad. Unelslwbee oad v .. .on beWeen send Norffi m If Me designer or installer leel the now mr aaaklonal IMorma(oMctmmenls,h may be seethed. Record draining may also be on a separate page aeadmd. N°'Pages Atteatea CERTIFICATION OF INSTALLATION INSTALLER DESIGNER f certify that I installed tire system in acwrtlance with I certify That the system has been installed in a=r- the septic design stamped APPROVED"by Meswr dance with the septic design stamped APPROVED"by County Public Health and that any deyiations shown Masan County Public Health end that any deviations here have been cleamdyapproved by both the tlas shown here have been crearedyapproved by both and Mason County Public Health end meet all Stale myself and Mason County Public Health and meat all and Mason County Codes. State and Mason County Codes I further certify that all information contained on this I N Ihw eenily that ell informellon contained oa this than and arm shed Record Drawing is accurate. form and attached Re_corrddtDmmng is accurate. �JA 4 1n.2-\5 d' V1 Qf1 v,,ni(arcwinsaller AAR1, r U)V1 I IWO( Phnted Name Of SignaeOn W MASON COUNTY PUBLIC HEALTH W O The undersigned approves this installation Report and Fy�OFsffpta Record Drawing on behalf of Mason County Public DNA Health. Glalli Signature of En mental Health Specialist Date (desagnera stamp, signature and dale) THIS FORM MAY BE SCANNEDANDAVAiABLE FOR PUBLIC VIEWON THE MASON COUNTY WEB SITE nwwat�mr Printed from Mason a . "u | { | \ dill | ] [la , �& 14 it „ | ! � . ,/ � � � . . . � ) § ! � • � 3 » / � 7 ! RHR6 / m Mason County ( ( ) ) ( ) § ) _ ( � & ( k \ 7 { f ) 7 § ( § ) \ / !