HomeMy WebLinkAboutSWG2001-00374 - SWG As-Built - 6/24/2003 1ca7/_.c,)c-
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ASS-BUILT FORM Revised January 4,1999
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Applicant -t- trfri 1Z Assessor's ���� 3 r
�/ Parcel # 7 7- e) gO
Permit Number SWt;i2/- �3 7 7 (Twelve-Digit Number)
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Installer /�S J/A � Subdivision �� (NamelDlvlsion/Blook/Lot)
Designer SA' 4 '
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N/A Yes Prior to Completion
I. SEPTIC TANK
A) >5 ft.From foundation?
B) >50 ft from wells and surface water? CI
C) Bldg stub-out to septic tank:clean-out if not 1-2%7 0 0
D) Baffles intact and clean? 0 frrEr- 0
E) Dividing wall intact?
0
F) Risers installed for access? 0 171- 0
G) Tank Size; t'2-00 gal.;Manufacture , i
II. D-Box
A) Leveled with water? Zr 0
B) Speed leveler used?
III. DRAINFIELD
A) >10 ft from foundation and>5 ft from property lines? D 42-
B) >100 ft from wells and surface water? O 17
C) >10 ft from potable water lines? 0 'la-
D) Laterals level to±1 inch&end caps present if not looped? 0
E) Gravelless chambers utilized? 11-) t.t 7?-QT.01- '. .(.N r. 4 0❑ C]
F) System dimensions the same as shown on the design? 0 �� 0
0
• G) Gravel clean,properly sized,and proper depth?
H) PRESSURE SYSTEMS
1) Sand quality ASTM C-33? a El0
2) Head height uniform and �24 inches? Actual head height 36-(-
3) Clean-outs and observation ports present? 0
4) Mound: Side Slope 3:1? 0 0
5) Owner informed electrical connections must be made
by owner or licensed electrician and inspected by L&1? 0 )2-----
IV. PUMP/PUMP CHAM: - - ..2---A) Screen basket or uent filter c' one)installed? Cl ��
B) Riser installed for : 0 �I� 0
C) Alarm installed?
D) Pump make k-ctiffk.A NC4'/t . ; Pump model 5 'O
B) Chamber size/7A1) gal; 2-s- gal/inch; Chamber Manufacture , i-7�?iQS -
a
F) Pump chamber draw-down /,G inches per minute; Height of pump off bottom of pump chambers _inches
G) Pump controls:Timer(or)Elapsed Time Meter (circle if installed); If tinier is used:Pump On /' •'.. 'ff
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CHECKLIST \ 1 /�
1Drainfield&manifold NS- ' CC a' A S " 1�.—
orientation &layout — ---, — --� �6<. / C y \•.. l�V r- ? (,,:,lE L1 l D/t-
,Trench/bed dimensions I C -% `�' "� tJ 5tr(�
and critical distances r
within layout, ` S ,
'( A-rrel-�XTcly" I I Ja1 V 4 !'11,�' l
�Septtclpump tank zo,va ' d ,"t.''div1,0 rc"`r I
placement. i�` t " 'Y." o e ' V-
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Location of buildings. G 3 tr 'N
•
(Observation port&clean- �.sl • 69 ' z'�d g
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out location. ` �4' • stb— �° F t]iNR�
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O'�I.ocatlon of wells& ` K' l Vt' f'
I�r ads. \ I° •
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T Undisturbed native soil ill �� ''�N y c
between trenches. �s r
orth arrow ,` '��� 1
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CAUTION:Minor adjustments to septic tank location and drainfietd 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 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 the system viability. Any deviations from the approved design must be
shown above.
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Installer Check a box from Row"A"and"B",sign and date the certif ation
A. CII certify that I installed the system without any I certify that all deviations from the design stamped
deviation from the design stamped"APPROVED"by "APPROVED"by MCDHS are shown above.
CDHS
B. certify that I contacted the designer and left the
I V ❑ I did not contact the designer prior to final cover because the
system open for inspection up to 48 lus prior to designer waived the notification requirement.
cover.
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 'cation. f
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J
Si a sta er Date
The undersigned approves this installation on behalf of Mason County Dep ent f Health S rvices. /
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Sanitarian Date