HomeMy WebLinkAboutSWG2022-00033 - SWG As-Built - 7/14/2025 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
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Permit Number SWG 2 C2 2. .-0 0 C 3 3 Assessor Parcel# 2 Z 21Z4J 3 COO z 7
Applicant Name wal,S TYUS +� CfA L. ‘katiticivision (Name/Div/Block/Lot)
Applicant Address pjkLt'feXit:41 , ((R
--/'T C1 I C c-f cL Installer Name 511G47€ ( W!St4,
Site�c� ress I RiT)�1 IO� B-t r Designer Name S .2 191
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type I) t C Da IYZ-Q r / 1)t 1 V) Pretreatment Type Si3 t L. Oa Im e. 1/-
>5 ft. from foundation? - �����;;� �N/A YES El NO
>50 ft. from wells?
>50 ft. from surface water? - ❑ ❑
z� Cleanout between building and tank? JUL 1.7_ 2023_ _ . ❑ p' ❑❑
0 Tank baffles present? - ______,�� ❑
a 24" access risers over each compartment?- BY:-- = ❑ L� 0
W Effluent filter installed?- ❑ nn
N // , ! t gal u) Manufacturer Eve cj L u 17 l'Y r C L( t
Septic tank size i ( L 1
0 D-box water level and speed levelers used? - - ❑ N/A 'YES ❑ NO
❑
J
DO Manifold/D-box accessible from surface?- ❑ Q-
� ❑
mZ Check valves installed? - Ij `❑ (� [E
o2 Transport Line Size
Schedule/Class l 1 �� ,l` (C)
Bedrooms installed (check one) 9J 2 ❑ 3 El 4 El 5 ❑6 ❑Commercial/Ot r
>10foundation? - - ❑ N/A 7ES ❑ NO
ft. from o - ❑ � El
0 >100 ft. from wells?- ❑
W >100 ft. from surface water? ❑ ❑
>10 ft. from potable water lines? ❑ ITV ❑
� > 5 ft. from property lines and easements?- • ❑ CR
a - ❑ L� ❑
lY > 30 ft. from downgradient curtain/foundation drains? ❑ ❑
o -
Drainfield level and observation ports present ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one) CI
cover installed over drainfield?- - ❑
Pump tank setbacks consistant with se tic tank? - - ❑ N/AA
2C ( �ES ❑ NO
• Pump tank size 1 2� qal ) Manufacturer EV e G'CY-el I� )Y�(CS 1
r,/ ❑
< 24" access riser(s)and accessible from surface?- - -
0
a ❑
F- Alarm or Control Panel Installed? -2 Control Panel equipped with ime r ETM/Counter - El ❑
D
n- Pump installed in ❑ Bucket or MrOn Block or ❑ Other
r� ' ❑ Transducer
o. Pump Make/Model V� R A (C 7 F 7 0 05 ❑Floats or
RTank draw down IA (( in/min Pump capacity (I JCL— gpm Squirt Height it /C'�
. C t�r C Daily flow set at :� q
Pump on time f �Vl l I Pump off time
pd
Updated 12I72075
r
MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# 3 \ 5E(.:01:) -1
RECORD DRAWING
143 Drainfield&manifold
orientation&layout
w/dimensions for
re-location.
Trench/bed
dimensions and
critical distances
within layout
tyl Septic/pump tank
placement
O' Location of buildings
existing/proposed
vsl Observation ports.
dean-out locations.
&manifolds/d-boxes
(l Location of wells.
!! surface water.roads.
&waterlines
❑ Reserve area(s)
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 a/id\
atfe ed cord Drawing is accurate. form and attached Record Drawing is accurate.
—1
Signature of Installer Date %)4 a-2.6 4-3
y
it
Printed Name of Signee . . 9/l
-h.- ;AVi
MASON COUNTY PUBLIC HEALTH r ' ,.'���j)
The undersigned approves this Installation Report and ��� ,�, �����/�
Record Drawing on behalf of Mason County Public f. . .or.- •'•`��9I
�i°' on or Killian 'elzel•. ill
Health:0.-)„,2,n,,r1 ri-C
A LICENSED DESIGNER •
12-et-7A
Signature of Environmental Health Specialist Date (designers stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE opdateo.2nnc15
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