HomeMy WebLinkAboutSWG2023-00264 - SWG As-Built - 5/7/2025 . 4
RECORD DRAWING (ASSU LT)) pg. MASON COUNTY PUBLIC HEALTH
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Permit Number Sri G Z Z 3_-o0 ,�,. .^ Assessor Parcel # 3zoo •0-o.30/,y'
Applicant Name "&'.1l fit_ :lbasejia..._- Su bdivlsion (Name/Div/Block/1.ot)
Applicant Address //;570--.. .�_..- o.Lek....-._-..._.. /
City, , ..
y, State'. Zip 5,/ . .,. .1• _..q ._._� installer Name 1/4 ..r� ,4` ___
: Site address .�.)104..._....45 A -;�..� Des:finer Name jiwt /. .42-• aid ASsiv,
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INSTALLATION C## UI{L.iST
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4 rfsl Full System Installation ❑ Septic Tank Only 0 ' ainfield Only ❑ Repair
System Type P. -554MA_ ____ 'rear•-tment Type ____ _�
w _•.._>5 ft. from foundation? - - • -- - �b.'; IA ff YES ❑ No
>5t0 ft. from wells? _ _ _ _ _ _ _ _ _J.gyo ft'tZ 0
. J 0 ❑
>Soft. from surface water? - _ - _ - _. _ _ _ - _ - - _. _ - _ .- y�� -6/
1 •s Cleanout between buildins and tank? -- -• - - - - CFj. t1 0
Tank baffespresent? . _. _. _ _ _ _ .. _ ._ - _ .. _ _ FO ❑ 2 0 I
i•
t24"access risers over each com,artmer.t?_ _ _ .. _ _. w 2 (]
COI Ili Effluent filter installed?- _ _ _ _ .. _ _ _ ._ _ _ _ .- .. .--J- El 0
1 Septic tank size /6406 ga; - t,.!a_.ufacturer. - 't c//' i- -►•- _
as 0-box water ie';ei anc speec ievelers used? - •• - KI NIA ❑ YES ❑ NO
�L?; MenifoldiD-box accessible from surface?' - - •- •_ .. _ _. _ _ .
''wiu. .
t' i J Check vai'es instaileo'7 . _ .. _ .. _ _ .. _ .. U4 0 ❑
oh:
r Transport Line Size_ .� Fw Sch'scu!e/CIass $� 6
Bedrooms installed(check one) tiz 2 D 3 ❑4 0 5 ❑6
•
>10 ft. from foundation?- - - - -- -• - 0 N/A pil YES (l NO
'' f . >100ft. from 1,vells? - _ _ _ _. _ ._ _ _ .. _ ._ 0
- >100 ft.from surface water? - - - - -- - 0 gl 0
W •
iL >10 ft. from potable water lines?. - .. _. _. _ _ ._ _ _ ._ 0 :! ❑
- > 5 ft. from property lines and easements?- • ❑ rz ❑
. > 30 ft. from downoracfie:t curtain/foundation drains% - 0 [l 0
Drainfield level and observation ports present - •• • 0 - 0
0 Craveless c Y�chambers or Clean gave' used? (check one)
Proper cover installed over drair?fiela?_ ._ _ .. _. Y 0 (,i[ 0
^ Y Pump tank setbacks consistent with septic tank? - • - - -• -- ❑ N/A ❑ YES 0 NO
��
°w: Pump tank size_f D_4'L�__ __gal ': anufacturer�-/tiiii,
.� 24"access riser(s) and accessible from surface?- -• - ❑ 54- 0
0. Alarm or Control Panel Installed? - - El. (N ❑
Control Panel equipped witn Timer I E T M'Counter- 0 Z 0
1 (1° Pump installed in Z Bucket or ❑ On tlockJJ or ❑ Other
E halce'Mcd'-'L,•)� l4_0 v Serkfj (Floats or 0 Transducer
Pump lvla:cr ,uo. i
1 --Tank draw down _r- ____in/min Pump capacity ^_gpm Squirt Height, 4 ft
Pump on time, l pu;np off time i- Daily flow set at v2•4T Wm
tov1sed 1/22.2014
RECORD DRAWING (ASBUIL`f) Mfg. 2 MASON COUNTY PUBLIC HEALTH
i 4. ,,, ,•m,.� ..n,,,�_ RECORD DRAWING
NG
rj Drainfiela&
manifold orientation
&Iayo.:t
j ci Trenchibed
. dimensions and
critical distances
within layout
c Septic'pun:p tank
placemelt ,
E •
•
Loca;ior,of
i buildings
! 0 Observat;on ports&
clean-out locations
Loca;ior of welts.
surface•pater.&
4 roads
0 Undisturbed naive
9 soil between
1 ritrenches
North Arrow
IIf the designer or installer feel the need for additional information comments,it may be attached.
,ecord drawing `tEy also be on a seperate page attached. No. Pages Attached
�,. ,Fes..,,. ... . . ...._ _ . . . . .
CERTIFICATION OF iNSTALLATlOW
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
j County Public Health and that any deviations shown Meson County Public Health and that any deviations
here have been c1nared/approved by both the desipier shown here have been cleared/approved by both
and Mason County Public Health and meet all State I myself and Mason County Public Health and meet all
• and Mason County Codes. State and Mason County Codes
1 further certify that all information contained on this I further certify that all information contained on this
I form and attached Record Drawing is accurate. , form and attached Record Drawing is accurate.
li
Signature of instailer Date CT,,..'t:•, , h�.
r / ut
1 _...,?8,Kizatkere--- ,\` ' '..3 /71 —
i Printed Name tx'Signee I ( ,-,.
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MASON COUNTY PUBLIC HEALTH
Q'._:
The undersigned approves this Instalratton Report any i 5 d ;. 1)1
Record Drawing on behalf of Mason County Public A„ s1• ut,
ar4•r ,,.•.iart *,
Health: `t:;.f, ,.1.. rF t,
// • ` •ir-1{
ik -g\m/y\cciry,_ _Signature of Environmental Health Sne_tsi of Date ) (designer's stamp, signature and date) J
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THiS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
revised 1.22/20i4
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