HomeMy WebLinkAboutSWG2023-00273 - SWG As-Built - 7/15/2026 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG LA -COa--1"3 Assessor Parcel# ,2O\-1 e2O0C1a
Applicant Name 17c1\F\F. K-Cl\Fr\ Subdivision (Name/Div/Block/Lot)
Applicant Address itoS110Yf., k71 (%
City, State, Zip S\ ktCllyu)Pr S4 Installer Name T\'ny\011 T\10\v1ySYl
Site Address SC1111K, GS CtVCQQ- Designer Name TYPY%VAkI1 C, C\Y
INSTALLATION CHECKLIST
%Full System Installation
❑Tank(s)Only ,. ❑ Drainfleld Only ❑Repair ❑Other
System Type tj \2 S U Y HA - ? Pretreatment Type-) '(/ 12
>5 ft from foundation? --- - -- -- - - - - - - ❑ N/A YES 0 N
>50 ft. from wells? -- - - - - - - - - - - - L - #,- Lr��}i"? 15 ❑ ❑
Z >50([. from surface water? - - - - - - - - ^ - - - - - -- - - - ❑ , I ❑
FQ- Cleanout between building and tank? - - - -JUL IJ-8-1026- 19, ❑
Tank baffles present? - - - - -- - - - - - - - - - - - - - - - - - 16 ❑
a24"access risers over each compartment? By- - - \ �- - -- 14 ❑
W Effluent filter installed?-- - -- -- - - - - - - - -- ---- ❑ d ❑
0
Septictanksize , gal Manufacturer P ( / reIn
0 D-box water level and speed levelers used? - -- - - - - - -- - - - - - ❑ N/A VES NO
OJ
LL Manifold/D-box accessible from surface?- - - - - - - -- - -- - - - - - ❑ ❑
E9 Check valves installed? - - - - ---- -- - - - - - - - - --- -- - - ❑�,,{{ {{ pp d ❑
O2 Transport Line Size I ° Schedule/Class �(fd/AUtl. _IV
Bedrooms installed (check one) 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - - - __ __ ____ _ __ _ _ _ _ __ _ _ _ _ - ❑ N/A YES NO
>100 ft. fromwells?- _ _ _ _ _ _ __ __ _ ______ _ _ _ _ __ _ __ _ - 0 ❑
W >100 ft. from surface water? - - - - - - - -- - - -- - - - ❑ 17-), ❑
u. >10 ft. from potable water lines?-- - -- --- - -- - - - - - - - - - - ❑ ,W ❑
z > 5ft. from property lines andeasements?- - - - - -- - - -- -- - - - ❑ ❑ ❑
2a' > 30 ft. from downgradient curtain/foundation drains? - - - - - - - -- ❑ m El
0 Drainfield level and observation ports present - - - - - - - -- - - - -- ❑ d ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed overdrainfield?---- - - - - -- - -- -- - -- - ❑ ,�❑ ❑
Pump tank setbacks consistent with septic tank?---- - - - -- --- - ❑ N/A IJJ YES ❑ NO
Y Pump tank size I OO( oal Manufacturer, eccls
2El
Q 24" access riser(s)and accessible from surface?-- - -- - - -- -
-- -
F
a Alann or Control Panel Installed? - - - - - - - - - -- - - -- - - - - - ❑ El
^8 Control Panel equipped with Timer/ETM/Counter- -- ---- - - - - ❑ ❑
7
a Pump installed in ❑ Bucket or On Block or ❑ Other _______________________--
0.
Pump Make/Model LOW RIDGE OSCAR OSXOA tg Floats or ❑ Transducer
Tank draw down NA in/min Pump capacity I0 pm Squirt Height NA ft
Pump on time 3 S EC0N 15 Pump off time 3 MIN SEC Daily flow set at 440 gpd
npdO dlNIX15
MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# 220175200072
RECORD DRAWING
• Drainfield&manifold
orientation&layout
w/dimensions for
re-location.
Trench/bed
dimensions and
critical distances
within layout
• Septidpump tank
placement
• Location of buildings
existing/proposed
• Observation ports.
clean-out locations,
&manifoldsld-boxes
Location of well,
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 separate page attached. See Attached Drawing 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 hem 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 site ed R cord Drawing is accurate, torn and attached Record Drawing is accurate.
Signature of In a ar Date
%RAN4(i I DMP50M .
Printed Name of Signee
MASON COUNTY PUBLIC HEAL_Hpp- ,m„
The undersigned approves this IhsPEAatir ttoPd
Record Drawing on behalf of Mason County Public 13JuIy2025
H �lls�zaZ�l
signature of Environmental Health Specialist bdl} (designer's stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VrEW ON THE MASON COUNTY WEB SITE uFew.a+annms
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