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HomeMy WebLinkAboutSWG2024-00365 - SWG As-Built - 12/19/2025 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH...__. PARCEL IDENTIFICATION � _ Assessor Parcel# `��l3�/S�� f Permit Number SWG;ipa�/•C �3(<� 7 Subdivision (NamelDivlBlocklLot) Applicant Name Jet( Frei � • N� ' • Applicant Address ) DI � ��j�I City, State, Zip p L`1 i Q I A , W'�- 6ti S 'i (0 Installer Name ( - rc-t,a F- G� c Site Address G -,y,,t�', C-bilo Designer Name INSTALLATION CHECKLIST ._ _ __ - ---•- --_... _.. Repair ❑Other lull System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ P �, Pretreatment Type System Type • u - . ,� ❑ N/A •YES 0 NO >5 ft.from foundation? - �fiEcEll_rEavii [� ❑>50 ft.from wells? - [� ❑ >50 ft.from surface water? / ey, _- ❑ ❑� �1. ❑• Cleanout between building and tank? -t ^�2�5 ❑ [' • Tank baffles present? El ❑ ❑ a24"access risers over each compartm: `•��j i __ _ ❑ Clic ❑ � Effluent filter installed?- I � „�. J� Septic tank size 1 / C/ gal Manufacturer - "NIA ❑ YES 0 NO CI D-box water level and speed levelers used? - El LSI- ❑ ~, ❑ �O ManifoldlD-box accessible from surface?- - 0 � u. n92 Check valves installed? - n< 2 Transport Line Size Schedule/Class 5% 2 0 3 ❑4 Ell5 El 0 Commercial/Other Bedrooms installed (check one) ❑ NIA ® YEs ❑ No IN >10 ft.from foundation?- CICI• >100 ft.from wells?- CI IN IDW >100 ft.from surface water? - • - El a 0 tr. >10 ft.from potable water lines?- 0- Et ❑ • > 5 ft_from property lines and easements?- ❑ 2 >30 ft.from downgradient curtain/foundation drains? - - 0 C& 0 O Drainfield level and observation ports present ❑ Graveless chambers or ❑ Clean gravel used? (check one) 0 0 Proper cover installed over drainfield? Pump tank setbacks consistant with septic tank?- ❑ N/A UichYEs NO • al Manufacturer .5),_. 'ci� ---- �'�. Pump tank size nan —g ❑ 0 z 24"access riser(s)and accessible from surface? ID eL Alarm or Control Panel Installed? El ® Li Control Panel equipped with Timer/ETM I Counter 0 D CI- Pump installed in ❑ Bucket or ❑ On Block or ti' Other —_ CIFlooto or �rronoduoor • rump MaKc(Modcl - �- - eL Tank draw down , h Pump capacity gP m Squirt Height ft �. Daily flow set at gpd Pump on time Pump off time Updated 1711/2015 i IVICP11 RECORD DRAWING (ASBUiLT) pg. 2 Assessor Parcel# RECORD DRAWING Drainfield&manifold orientation&layout wldimensions for re-location. ElTrenchlbad 1 dimensions and critical distances 4 within layout [� Septic/pump tank placement Li Location of buildings existinglproposed D Observation ports, q clean-out locations. &manifoldsld-boxes 4 � Location of wells, surface water,roads. &waterlines. 0 Reserve area(s) , ❑ North Arrow If the designer or installer feel the need for additional information/comments,it may be attached.No.Pages Attached Record drawing may also be on a separate page attached. CERTIFICATION O` F INSTALL ATION INSTALLER I DESIGNER E the system has I certifythat 1 installed the system in accordance with ! I certify dance with tthe septic design stamped!APPROVED"by ' the septic design stamped'APPROVED"by Mason • 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 haveave been1e Publiapproved c Health and mby eet all th and Mason County Public Health and meet all State myself and County and Mason County Codes. State and Mason County Codes I further certify t all information contained on this I further certify that all information contained on this 11 1 form and attached Record Drawing is accurate. form and att ed R rd Drawing is accurate- w Signature of Installer Date CV!� S`r\ 1 1 0V. ^ Pointed Name of Signee —=i S!J west;,/ iliIig2 MASON COUNTY PUBLIC HEALTH '$" ;� � The undersigned approves this Installation Report and , •.+ `,IIt �%Uc 22030834 Record Drawing on behalf of Mason County Public ;, l4220 0834 ll_-. �k D DE51 NER ,, P , , yki (0 r7-V- 3 Signature of Environm ntal 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 Updated 12P7O015 r.r ti',11:;;V:. V /1 N 1',6 i I ,., :,.::.: � = o p�0 FM 00 D w NI N D ca. 1 - O • 71 mO PRwRY ,90'4 I. \l OL H I 1I J .,. _ _a cnr m 10'DOWN&9PE FSETBACK - o ilt 1D O o 30 ® m 3 m D CDill w CO co P° a D m CDO 1 I rrl 33 ---'c rrg x. 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