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HomeMy WebLinkAboutSWG2022-00567 - SWG As-Built - 1/26/2026 L fil JAN 23 2C23 (-- RECORD DRAWING (ASBUILT) pg. 1 BY: MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SI/VG ZO 2 2 - C•CS-6 7 Assessor Parcel # 2201 Applicant Name Subdivision (Name/Div/Block/Lot) Applicant Address 3n (05,... i RI City, State, Zip ,5,'ef-Lin £cl�} q2;5- installer Name 3r�t l�Aolk. rho 5 h4 i � Site Address ,-• 0 E (m e- p( W Designer Name (,i vial[ WIxf k INSTALLATION CHECKLIST -Full System Installation ❑Tank(s)Only ❑ Drainfield Only.t1 ❑ Repair ElOther System Type tvi.fc(+rcc,'{-pr Pretreatment Type >5 ft. from foundation? >50 ft. from wells? - ❑ NIA Q Yes ❑ NO Z >50 ft. from surface water? - �, ❑ ;; El Q Cleanout between buildingtank? . ❑ and O , 0 0 Tank baffles present? ❑ _ - /,_, ❑ }— 24"access risers over each compartment?- ,' * O u W Effluent filter installed?- _ _ _ _ - _ _ - ❑ O Septic tank size_.•16e0 gal \^',r Manufacturer 71.:"..c• \ i-u ._ 0 D-box water level and speed levelers used? 1 0 N/A ❑ YES ❑ NO OO Manifold/D-box accessible from surface?- - O ❑ 0 Da Check valves installed? - - - - O Ski 0 ,tSk 2 Transport Line Size L__- Schedule/Class Sc(a `l 0 Bedrooms installed (check one) ❑ 2 0 3 0 4 O 5 ❑g 0 Commercial/Other >10 ft. from foundation?- - O N/A O'YEs >100 ft. from wells?- - ❑ NO El W >100 ft. from surface water? • _ 0 Q, 0 u. >10 ft. from potable water lines?- _ ❑ ©. 0 Z > 5 ft. from property lines and easements?- - - - - -. .. 0 30 ft. from downgradient curtain/foundation drains? - O O Drainfield level and observation ports present . . ❑ d O O Graveless chambers or [(Clean gravel used? (check one) Proper cover installed over drainfield?- ❑ 0 Pump tank setbacks consistent with septic tank? _ - O NIA EYES O NO Z Pump tank size 1060 gal Manufacturer r 4, . .. \T,- -----' ,- < 24"access riser(s) and accessible from surface?- _ O Er O O. Alarm or Control Panel Installed? - - 0 r;r' ❑ 2 Control Panel equipped with Timer/ETM/Counter- - O 0 O- Pump installed in 0 Bucket or [/On Block or ❑ Other a- Pump Make/Model L- t\Oaf V—•y 'loats or O Transducer dlank draw down 2 -5 in/min Pump capacity t.'u gpm Squirt Height !`. 2- ft Pump on time LAG S c c_ Pump off time -4-- Daily flow set at -(.Q gpd ,( / Uodated+2�?'2C.15 3'd MCPH RECORD DRAWING (ASBUILT) pg, 2 Assessor Parcel# Z 201 "S-- ( —COO K RECORD DRAWING 0 Drainfeld&manifold orientation&layout w/dimensions for re-location ❑ Trenchibed dimensions and S P4,1 /Joo ow..-- Cl o'1-ni ev critical distances within layout 1 i eft,'e q4-( del pQi,-ki 4 4'1 ❑ Septic/pump tank placement [3i c Location of buildings 2 PC/Appt2 r2,a 1 r r ep J ic existing/proposed T� / O Observation ports, / ` ?r fl l clean-out locations &manifolds/d-boxes o/3i 5770%10 6."‘ "N /C ii,, ) 4. ❑ Location of wells, �, n ' surface water, roads -t_!� (PQ GP� &waterlines OReserve 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 F INSTALLATION INSTALLER DESIGNER I certify that I installed the system in accordance with 1 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 alt d Reco swing is accurate, form and attached Record Drawing is accurate. I tc 1t14 .���l Sign we f InstallerE Date 4- � G S'''—' ,��� qtr•. `.A Printed Name of Signee AT v MASON COUNTY PUBLIC HEALTH �.. c? 5100.1 ‘ The undersigned approves this Installation Report and o ENSE WgITE ?� Record Drawing on behalf of Mason County Public =- Ll�`SED DESIGNER Heal EXPIRES u5;10,lthI �ILnt l [.- 67:.z ca Sign to nvironmental Heal th Specialist Date (designer's stamp, signature and date) ` THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE tJnoa:ed 12772015 1. Existing two bedroom residence 2. Proposed 20'x24' garage w/ bonus room 3. 1060 infilitrator septic tank 4.14-1-.a 314 12 too Al u x+/44• 4. 1060 infilitrator pump tank ,"..r. 5. Primary drainfield p. 648 sf reserve drainfield 7. Audio/visual alarm APPROVED 8. Clean out 9. Transport line JAN3 2013 10. Valve box MASON COUNTYENVIRONMENTAL HEALTH 11. Waterline RED. (? �lra ,o auks h)_ . _..- 7�' . 1 nr 6 -24 ": t o+r,1 ..") 1 ,�; , x.4.,8 , , i .4y. N.s I. i 1 , t . 1, 7.0. 7 ! i/``� A'A AI f WD E. 1:P. ,to i 112.' . 4,6 ' LICENSED DESIGN .ho• ��' �� EXPIRES 115,10, ` �� ,1 I ' T N.� `\\\ Y 1 __.. I sVP' a.' .� JAN 2 6 ''' ''I‘ 1, 30 r ca,,...,„ „ f ���� :e_.r_. - MASON COUNTY ENV/RON E a. ',W i M_NTAL HEAL Jilitfif c "'�`t. "* i-:r„;' ,...3:')e".;0 tom' 20' /, 1 f 1 ` 2a'