HomeMy WebLinkAboutSWG2020-00493 - SWG As-Built - 8/18/2021 (2) p D
RECORD DRAWING (ASBUILT) pg. 1 ( MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SING 2Q%, (pQ '</CJ3 Assessor Parcel# 12 Z 3 Z 109/o& 3
Applicant Name [, v}OQ. C�C,p')/) �l ! 1Y ubdivlsion(Name/Div/Block/Lot)
Applicant Address L'L S Ik1 -A
City, State, Zip 't(, IQ (!JA Installer Name SSI)t flS U/tih b
Site Address 3L — ) , Designer Name TI iin- rAcriakc
INSTALLATION CHECKLIST
oil System Inatauaton ❑Tank(s)Or, ❑ Drainfeld only ❑ repair ❑Other
System Type � S�5 i Pretreatment Type /r2
>5 it from foundation? __ _ _ __ _ _ _ _ _ _ _ __ _ _ _ .. . -- ❑ NIA YES ❑ No
>50ft. fromwells? -_ _ _ _ _ _ _ _ _ _ - _ _ __ _ _ _ _ _ _ _ _ -. _ _ _ _ _ ❑ ' ❑
Z >50 ft. from surface water? - - - - - - - - - - - -- - - - - - - - - - - ❑ P4 ❑
Fa- Cleanout between building and tank? - - - - - - - - -- -- - - - - - -- ❑ ❑
Tank baffles present? - - - - - - - -- --. - - - - - - - - - - - - -_. - - ❑ ❑
A 24" access risers over eachcompartment? - - - - - - - - -- - - - - U U
-
W Effluent filterinstalled?- - - -- - Z - - - - - -- - ❑ ❑
Septic lank size /ZS(D ` g Manufacturer S❑U (,tQf
O D-box water level and speed levelers used? - - - - - - -- - - - - - - NIA ❑ YES ❑ No
J
00 Manifold,'D-box accessible from surface?- - - - - - - - - - -- - - - - ❑ ❑
mZ Check valves installed? - - - - - - - - - - - - - - - - - ❑ ❑
/e
Transport Line Size ___________ Schedule/Class 200
Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 Z6 ❑Commercial/Other
>10ft. from foundation?- - - - - - - - - - - - - - -- - - - - - - - - - - - ❑ NIA YES NO
❑ >100 ft. from wells?-- - - - - - - - - - -- - - -- - - - - - - - - - - - - ❑ ❑
-a >100 ft. from surface water?- - - - - - - -- - - - - - - - - -- - - - - - ❑ ❑
ri >10ft.from potable water lines?- - - - - -- - - - - - - - - - - - - - - - ❑ ❑
Q > 5ft. from property lines and easements?- - - -- - - - - - - - - - ❑ ❑
tY > 30 ft from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ❑
O �Djrtainfield level and observation ports present - - - - - - - - - - - - -- 5 ❑
19 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed overdrainfield?- - - - - - - - - - - - -- - - - -- ❑ ❑
Pump tank setbacks consistent with septic tank? — -- - - - - - -- - ❑ N�/A1�. YES ❑ NO
Pump tank size I son gal Manufacturer—±L4/I__. -_
Q24" access riser(s)and accessible from surface?- - - - - - - - - - - -- 9 ❑
Alarm ar Contral Panel Installed? - - - - - - - --- - - - - - - - - - --
❑ ❑
21 Control Panel equipped with Timer/ ETM/Counter- - - - - - - - - -- ❑ ❑
7
- Pump installed in ❑ Bucket or''``I On Block or ❑ Other_- ,,_�rr��
L Pump Make/Medea ��(Pr Iy'153 �frloats or 1J Transducer
d Tank draw down I-SI in/min Pump capacity tt/�2O gpm Squirt Height �--� ft
Pump on time 11 S Pump off time "!'his Daily flow set at —]20 gpd
Updated 1N/20'5
MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel U
RECORD DRAWING
❑ Drainfield&manifold
orienatlon&layout
widimensions far
re-location.
❑ Trench/bed
dimensions and
critcal instances
within layout
❑ Septic/pump lank
placement
LJ Location of buildings
existing/proposed
❑ Ohsen tion pods,
clean-out locations,
&rnantfoldsld-boxes
❑ Location of walls,
surface water,roads,
&waters nes.
❑ 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. 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 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(hat al/information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate, form and attached Record Dr g is accurate.
Signature o.Installer Dale
- � 'zt
,w^
Pentad Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and q
Record Drawing on behalf of Mason County Public
Health: �
s` %zlZL
� eh`-twV'\ ti jVbI21
Signaure of Fnvlronmenta Health Specialist Date (designer's stamp, signature and date)
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