HomeMy WebLinkAboutSWG93-00582 - SWG As-Built - 4/25/1996 ON-SITE SEWAGE INSTALLATION
FINAL INSPECTION
DATE CALLED IN: 14-1
TIME:
INSTALLER:
APPLICANT/OWNER: 04).) D. V U
CALLER: h
PHONE # OF CALLER: ( -)&- ST/ /
SWG #: 3 10.SO"
PARCEL NUMBER: 3;L? 1--- <00 --
SUBDIVISION: c fj?
DIVISION: LOT: ; CTI?$ L47-56
SYSTEM TYPE (CHECK ONE) : r-1
PR.EIRE GRAVITY
INSPECTION SCHEDULE (CHECK ONE) : (-1
L_J
APPEaMENT PLUG IN
AS-BUILT ON-SITE? (CHECK ONE) : 1-1
II
YS NO
STAFF INITIALS:
h:callin.w
Revised 02/01/95
ON-SITE SEWAGE INSTALLATION
STAFF INSPECTION REPORT
STAFF CHECKLIST
CONFIRMED BY INSPECTOR?
I. SEPTIC TANK Yes No Comments
A) >5 ft from foundation?
a) Bldg stubout to septic tank: cleanout if not 1-2%?
c) Baffles intact and clean?
D) Dividing wall intact?
II. D-BOX Leveled with water or speed leveler (circle one)?
III. DRAINFIELD
A) >10 ft from foundation and >5 ft from property lines?
a) Laterals level to ±1 inch & end caps present if not looped? 4
c) System dimensions the same as shown on the design? LG
D) Gravel clean, properly sized, and proper depth?
E) PRESSURE SYSTEM ,� /',�_
I) Sand quality ASTM C-33? !1 H
s) Head height uniform and >_24 inches? "`""'///_---
3) Cleanouts and observation ports present?
4) Mound: Side slope 3:1?
Ae:r
s) Owner informed electrical connections must be made
by owner or licensed electrician and inspected by DLI? X
IV. POTABLE WATER LINES
A) >10ft from drainfield, transport line, and septic tank?
B) Wells >100ft from drainfield? _
V. PDMP TANK . •
A) Screen basket op'effluent fi er (circle one) installed?
a) Riser install or a s?
C) Alarm installed? '/
VI. AS BUILT REQUIRED? /(
VII. OTHER COMMENTS /// ��`
The undersigned has reviewed this install: ion and v if es these indings on behalf of Mason County of Health Services.
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Ne=l th nspe o �J�T• ' - Dat C
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h:callin.w
Revised 02/01/95
AS-BUILT FORM - PAGE ONE Revised 12/14/94
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PARCEL IDENTIFICATION I
•
I
Applicant's Name �
Permit Number SWG9 -(.�)-c&2, Subdivision 67442e Stff%�i er)
-Tame ivisi / tocx/Lot)
y
Installer's Name Tr kitrNP' Assessor's Parcel No. :3?- 510-elCra .
Designer's Name llweive-u1git Number)
1
INSTALLER CHECKLIST
I
�
N/A Yes Prior to
I. SEPTIC TANK Completion
A) >5 ft from foundation? _
B) Bldg stubout to septic tank: cleanout if not 1-2t?
C) Baffles intact and clean?
D) Dividing wall intact? t
II. D-BOX Leveled with water and/or speed leveler (circle) ?
III. DRAINFIELD
A) >10 ft from foundation and >5 ft from property lines?
B) Laterals level to ±1 inch & end caps present if not looped? K
C) System dimensions the same as shown on the design? _
D) Gravel clean, properly sized, and proper depth? _
E) PRESSURE SYSTEM
1) Sand quality ASTM C-33? _
2) Head height uniform and z24 inches? _
3) Cleanouts and observation ports present?
4) Mound: Side slope 3:1? -..4 —
5) Owner informed electrical connections must be made by
owner or licensed electrician and inspected by DLI?
IV. POTABLE WATER LINES
A) >10ft from drainfield? _ .L_ _
B) Wells >100ft from drainfield? A
V. PUMP/PUMP CHAMBER
A) Designed pump used, or specs at ached for equivalent pump? k'
B) Screen basket oiefnt filter (circle one) installed? 4-v _
C) Riser installed for a-cCes? T
D) Alarm installed?
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CERTIFICATION OF INSTALLATION I
I
'
Installer: Check box from Row "A, " check box from Row "B, " sign and date the certification.
n
A. u I certify that I installed the system A I certify that all deviations from
without any deviation from the design the design stamped "APPROVED" by MCDHS are
stamped "APPROVED" by MCDHS. shown on the reverse side of this form.
II
B. u I certify that I contacted the I did not contact the designer prior
designer and left the system open for to final cover because the designer
inspection up to 48 hrs prior to cover. 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 �c1er ' 'cation.
Signature o rnsta er 7/e
The undersigned approves th s stallI
on o behalf of Mason County Department of Health
Services. 1 fens•- �j�� �//
AS-BUILT FORM - PAGE TWO Revised 12/14/94
1 1
PARCEL IDENTIFICATION I
1
Applicant's Name ivTv iv b' VIL)
Permit Number SWG9 - 105got Subdivision ` 'do) . ►/rise &-ge4
/(NameiDivl.sl.on/B ocx/Lot)
Installer's Name T 1 k4/Cm Assessor's Parcel No. 3227 S0-41903o2
Designer's Name C70 (L Obhma fl -(Twelve-Digit Number)
I
1
AS-BUILT DRAWING
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_ y o o geFh /sh0/l0w 0 p, iG,, w)1Mh ,Saki Ax9.A11-77 4b/),
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39_L AT to A,o/ ,eirz--,
Voy 4/t'c//y Hee S'a,rJ. f5, --
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cal/ I
. 2c l C-3 3 ' I dikgee, , - /ova
dos/iAon, a/4
ef s 75'Q°f Beel s
/i of
CAUTION: Minor adjustments to septic tank location and drain field orientation made in the field by the installer are generally ac-
ceptable to both the department and the designer, but could in certain cases compromise the viability of the system. It is the
installer's responsibility to obtain prior written approval from either the health department or the designer before making any
deviations from the design that affect system viability. Any deviations from the approved design must be shown above.
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AS-BUILT CHECKLIST I
I' I
II
kf Drainfield orientation � Observation port location Undisturbed native soil
and layout between trenches
n Cleanout location I'
Trench/bed dimensions and I ' North arrow
critical distances within Manifold placement n
layout Scale of drawing shown
r�
Orifice placement on scale bar
D-Box/"T"/"L" location 5}
5t Lateral placement, with Additional Mound Information
1 1 Septic tank/pump chamber distances to edge of bed n
location r---1 u Endslope width
n U Location of wells, roads I-1
u Location of buildings U Overall fill dimensions