HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 5/7/2025 A
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RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION .
Owner Name 1/art I(P '--- Assessor Parcel# 32--}1 i-La y L,
Mailing Address 1_1 11 v v'> > -Ii I o: O/M Specialist Name
1/
City, State,Zip 0, >r _ - i c i4 el .> (6 Installer Name l?op R/ /�S/
Site Address -k%"I.. rJ v 4 tit.,; I'• _ Designer Name yvr✓��: ' 4,sSc'
Please complete this checklist to the best of your knowledge. If items are unknown leave bla
•
INSTALLATION CHECKLIST . - ilefY . -
A 2 i�
System Type -5-4 n,/' (//Geyer $,-- c)C <1 Pretreatment Type /t./..)1,-/--e- <c 4
Drainfield Ln.Ft. -- Drainfield Sq.Ft. ±-'-I U Drainfield depth 5`i- `.,
>5 ft from foundation? - - ❑WA YES ❑ NO
>50 ft_from wells? - - ❑ T2F ❑
z >50 ft.from surface water? - - ❑ la ❑
H Cleanout between building and tank? - - El 121 ❑
V Tank baffles present? - - ❑ a ❑
L24°ac Ass risers over each compartment?- - [] -at ❑
fW Effluent filter installed?- - CISI ❑
Septic tank size z2.3' gal Manufacturer 6 ,r� f L'(7.41 ‘/'r i L 7
0 D-box water level and speed levelers used? - - 0 WA ❑YES ❑ No
DO Manifold/D-box accessible from surface?- El
mZ Check valves installed? - ❑ ❑
I - '0
§ Tr ine Size Schedule/Class
Bedrooms installed(if known) 122 ❑3 ❑4 ❑5 06 ['Commercial/Other . /
>10 ft from foundation?- - ❑ N/A 12 YES IIM
0 >100 ft.from wells?- - gl El El
W >100 ft.from surface water?- - ❑ ® ❑
Z >10 ft.from potable water lines?- - ❑ a ❑
>5 ft.from property lines and easements?- - Elo� El
>30 ft.from downgradient curtain/foundation drains?- ❑ Ca ❑
o
Observation ports present? - - ❑ la ❑
0 Graveless chambers or a Clean gravel used? (check one)
Proper cover installed over drainfleld?- - ❑ CI, ❑
Pump tank setbacks consistent with septic tank?- - 0 tua ja YES ❑ No
`-� Pump tank size /t'lc' gal Manufacturer .3OLJN,, A« i''z 7-71
Q24'access riser(s)and accessible from surface?- - ❑ M" ❑
1-
II Alarm or Control Panel Installed? - - 0 g ❑
Control Panel equipped with Timer/ETM/Counter- - ❑ la ❑
ti Pump installed in ❑ Bucket or ta-On Block or ❑ Other
11*
Pump Make/Model ( / -c/4) �- %6-% fa Floats or ❑Transducer
R Tank draw down 07 in/min Pump capacity `f 5 gpm Squirt Height 2— ft
Pump on time / 12/ 1-' Pump off time �, Ii r- Daily flow set at /P/C) gpd
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RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
Dralnfleld&
manifold orientation
&layout
Trench/bed
dimensions and
critical distances
within layout
Ei Septic/pump tank
placement
El Location of
buildings
• Observation ports&
clean-out locations
El Location of wells,
surface water,&
roads
Undisturbed native
soil between
trenches
▪ North Arrow
If the designer or installer feel the need for additional information/comments, it may be attached.
Record drawing may also be on a seperate 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 Mason County Codes. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form attached Record Drawing is accurate. form and attached Record Drawing is accurate.
Signature of l staller Date
�R(LIN r oGG �`•. .?; r /
Printed Name of Signee ' w •
.
MASON COUNTY PUBLIC HEALTH
r,n/oai2 %•
.'
ram'
The undersigned approves this Installation Report and �(' ADAP4 J,fHUNTER .
Record Drawingon behalf of Mason CountyPublic t'iCt'r1S1'ti i.I' i�ISE.'r'd""
Health: Zl� �
V-7 (7—'S
Signature of Environmental Health Specialist Date (designer's stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
revised 1/22i20'4
US HWY 101
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