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HomeMy WebLinkAboutSWG2024-00250 - SWG As-Built - 12/5/2025 i RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG 20 t4 —002S0 Assessor Parcel # L{ZI ?_Z3ZO0OJ0 Applicant Name toy S kiksovt Subdivision (Name/Div/Block/Lot) Applicant Address 'Too E r+9:rKx14._ 1-16 City, State, Zip st .l w./ % aJ Say Installer Name :1 le/isIJ, n-42A Site Address l f' Designer Name A4" }7) - I INSTALLATION CHECKLIST ❑ Full System Installation M Septic Tank Only ❑ Drainfield Only ❑ Repair i -4�. System Type L.- 4- S4-ti,1-4 0�, Pretreatment Type >5 ft. from foundation? - ( -- ❑ N/A YES ❑ NO >50 ft. from wells? - { - - ❑ ® ❑ Z >50 ft. from surface water? -----Ir,,,.„,,,-,. - - ❑ ® ❑FQ- Cleanout between building and tank' O-2.BZ25- - -- ❑ gl ❑ V Tank baffles present? - - ❑ ® ❑ E- 24 access risers over each compartkF?-- - - i - - _ - ❑ E ❑G. I ` � �W Effluent filter installed? , .y == � 0 ❑ Septic tank size /7 ( O gal Manufacturer .1 ii P. 1 a''-'0 l , 0 ' D-box water level and speed levelers used? - - El NIA ❑YES ❑ NO oO Manifold/D-box accessible from surface?- - 21 ❑ 0 u. mZ Check valves installed? - - g] 0 0 CQ 2 Transport Line Size Schedule/Class 0 Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 0 6 4 ' >10 ft. from foundation?- - 14 N/A ❑ YES ❑ NO ci . >100 ft. from wells? ❑ ❑ W >100 ft.from surface water? - - a ❑ ❑ cc >10 ft.from potable water lines?- - IQ 0 ❑ Z > 5 ft.from property lines and easements?- - El d > 30 ft. from downgradient curtain/foundation drains?- - Fil 0 ❑ Drainfield level and observation ports present - - R- ❑ 0 ❑ Graveless chambers or 0 Clean gravel used? (check one) - Proper cover installed over drainfield?- - ❑ 0 ❑ • Pump tank setbacks consistant with septic tank?- - ❑ N/A El YES ❑ NO Y % Pump tank size 10`� gal Manufacturer T(a: 1 Q24"access riser(s)and accessible from surface?- - 0 ® 0 F- Alarm or Control Panel Installed? ❑ 0 a - 2 Control Panel equipped with4ir+lOf-/ETM/Counter- - ❑ t1 Pump installed in lig Bucket or 0 On Block or 0 Other mPump Make/Model _ (_ ..t.ciy 1.,40 igj Floats or 0 Transducer a Tank draw down 2— in/min Pump capacity /{-43 qpm Squirt Height /WA ft • Pump on time P 4,..o Pump off time-p&roc Daily flow set at pG *' qpm revised 1/22/2014 RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING • • Drainfield& manifold orientation &layout ❑ Trench/bed dimensions and critical distances within layout ❑ Septic/pump tank placement El Location of buildings ❑ Observation ports& dean-out locations 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 1 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 and attached Record Drawing is accurate. form and attached Record Drawing is accurate. /0/f Signature of Installer D to ra�43 ;II i n<5 Printed Name of Signee ,, ,. 11/2%?5 MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public ' I :F Health: AOAMJ HUNTER 0 ' ��� 11\\tip\\i :tt �. k_T 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 122/20/4 I 0 z l` co P 0, D S CD j - N O S -08 �N m v _m C7 v� M 5 0 m zo — vO co Z ' i D Qm C r r o <m Oc.71 D � i A ►� C5 / m ? rE / mI m a II . o z� /., 0 U mi�'rkil.N o x ' / Y �;.g,,,h1 3 111 hi, co 1 0 i' m0 1i1. m • 2 ox 4 -1 O CO o z XI / v -I CO z / ,''''' Cfl -I F 10 ? ±1320' 920 p L7 O D �s CO 0 F -< -i m Z - CO r D z IIm N r I- o X z o_ © _ ems, �, y - m m -1 O m m m 8 * * n m z O 1 . z ° 00 0 00 00 0w o x mr ca PAP*1/ • o o ` CRw _ 0 rn �] m n Z N � c CN / pmx,O rn = m = c m-13 mm n n1.'• D n 00 CA T3T1 O 0 C z ( N A co C cn 2 ✓ „ v_, 2 n O m D G mvi Z % r m D r- p 0 p 3 v r p 0 m �' -1 Pry z o 5ni m o m f- V/ m < a3 ZC r a o 2 1- m bm m .. z m o 0 GI o m N 2 X. \o N 0 o O1 -I I- Zl CA o m z I