HomeMy WebLinkAboutswg07-00044 - SWG As-Built - 3/19/2008 RECORD DRAWING (ASBUILT) Mason County Public Health
PARCEL IDENTIFICATION
8 7 _ vva Assessor's Parcel# 3 2..A. 3 2 SU C)I GC) f
Permit Number SWG �-1 (Twelve-Digit Number)
W ig>At,r.1-nc 7 l� /}L C L 4/IG Fr
Applicant's Name /Ye> i.{ 1'U _
Ci O CZ«4 (�GSubdivision /�P N Jul, t aTs y—y
c p (Name/Division/Block/Lot)
Applicant Address .Z25t 6 JSEIt /6y r i L/-' Installer's Name /1t0/.t4/ttYQ txcAyam(/Ott
City, State Zip t LS A<V A K !Atli _ o ? Designer's Name W/G L // M4 L .711tiv:5�'L.L--
INSTALLER CHECKLIST
N/A Yes Prior to Completion
I. SEPTIC TANK .57v( /- 5rivT� /IC> -PTA= /6‘)
evst
>5 ft.From foundation? ❑ 0 0
���
>50 ft from wells? ......................................................_........- ❑ 0 0
>50 ft surface water? ... _.......... ❑ 0 0
Building stubout to septic tank:cleanout if not 1-2%? 0 0 0
Baffles intact and clean?................................................_......... ❑ 0 ❑
Dividing wall intact? ............................................._...........- 0 0 0
Risers installed for ace ? ............................................-...... 0 0 0
Screen basket o effluent filter installe . (circle one) ........_...._._ ❑ ❑ ❑
Tank size:/5'4 U gal.; Manufacture: l(ic 5 A t:7 45 T
II. D-BOX
Leveled with water? 0 0 0
Speed leveler used? 0 0 0
III. DRAINFIELD 114.4 ,reci ,A
>10 ft from foundation? 0 0
>5 ft from property lines and easement lines? 0 0
> 100 ft from wells? 0 0
> 100 ft from surface water? 0 0
>10 ft from potable water lines? 0 0
Laterals level to±1 inch&end caps present if not looped? ❑ ❑RECEIVED c
Gravelless chambers utilized? 0 0 0
:
Gravel clean,properly sized,and proper depth? 0 0 0 NAR 1 4 NNI
PRESSURE SYSTEMS
•
Sand quality ASTM C-33?......................_.............. ..._... 0
6 v k:r`
Head height uniform >24 inches? Actual head height ❑ 0
Clean-outs and observation ports present') 0 0
Mound: Side Slope 3:1? ❑ ❑
Owner informed electrical connections must be made by
owner or licensed electrician and inspected by L&I?............. ❑ DIV ❑
IV. /f cv4.-D/N G l4-/Yf' / )(_, % /N- l ffP a u`r.---
Pump make ; Pump model ❑ ❑
Chamber size ial>OO gal; Manufacture /1'i R 3 fif/=5C 4 7-- 0 0
Height of pump off bottom of pump chamber inches
Pump chamber draw-down gallons per inch per minute
Pump capacity gallons per minute
Pump controls:Timer,Elapsed Time Meter,Counter?(Circle all ❑ ❑
that apply). If timer:Pump On Pump
Off
Riser installed for access?...................................................... ❑ 0
Alarm installed?........................................................... _ ....._ ❑ 0 0
RECORD DRAWING
CHECKLIST
❑ Drainfield& jl=G A l l fi co a l Ft Api
manifold orientation
&layout
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
placement
❑ Location of
buildings
❑ Observation port&
clean-out location
❑ Location of wells&
roads
❑ Undisturbed native
soil between
trenches
❑ North arrow (
/54. . .,
1 M .. �A`
h`W O,'N�N�A�
y�; S�..
sts•vs
e. n!iLIP.l�.§LiE aus§E;u;S
J LIGENtED DESIGNER Nk
WI' mex ',AY, ii//ii ii/'
EXPIRES 12/17/C.Z.
CAUTION:Minor adjustments to septic tank location and drainfield orientation made in the field by the installer are generally acceptable
to both the department and the designer, but could in certain cases compromise the viability of the system. It is the insaller's responsibility
to obtain prior written approval from either the health department or the designer before making any deviations from the design that affect
the system viability. Any deviations from the approved design must be shown above.
CERTIFICATION OF INSTALLATION
Installer: Check a box from Row"A"and`B",sign and date t ertification
A. 0 1 certify that I installed the system without any ID'I certify that all deviations from the design stamped
deviation from the design stamped"APPROVED"by "APPROVED"by MCPH are shown above.
MCPH
B. 0 I certify that I contacted the designer and left the 0 I did not contact the designer prior to final cover because the
system open for inspection up to 48 hrs prior to cover. designer waived the notification requirement.
I further certify that all information contained on this form is accurate. I understand that if the information contained herein is not
accurate,there will be just cause for immediate suspension of my installer certification.
/3/dr
Signature of Installer ate
The undersigned approves this installation on behalf of Mason County Public Health.
C L 0-4 3i IC(l0?
Environm tal Health Specialist Date
Revised January 2008
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