HomeMy WebLinkAboutSWG2022-00287 - SWG As-Built - 2/10/2023 •
RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2022-00287 Assessor Parcel# 321275400129
Applicant Name Montenegro-Ortiz Subdivision (Name/Div/Block/Lot)
Applicant Address 51 E Cromarty Ct
City, State,Zip Shelton, WA 98584 Installer Name Sam Hyatt
Site Address SAME Designer Name Adam Hunter
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair ❑Other
System Type sand lined pressure bed Pretreatment Type NONE
0 >5 ft.from foundation? - _ _ ❑N/A ill YES 0 NO
>50 ft_from walls? - D 1 11 U
Z >50 ft.from surface water? - - I ill o
H .Cleanout between building and tank? - FEB 1 5 2023_ El
V Tank baffles present? - — 1 El
❑ ® ❑
IT 24"access risers over each compartment?- , By .Won
iiii ❑
W Effluent filter installed?- _m. - 0
lit
cn
Septic tank size 1250 gal Manufacturer Snyder El
11 D-box water level and speed levelers used? - - ill N/A 0 YES 0 NO
O� Manifold/D-box accessible from surface?- _ 0 0
oZ¢ Check valves installed? - - ❑ 4 0
2 Transport Line Size 2" Schedule/Class SCH40
Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ NIA
� YES ❑ NO
0 >100 ft.from wells?- - ❑ +iii ❑
W >100 ft.from surface water?- - 0 III El
Z >10 ft from potable water lines?- -
Q >5 ft.from property lines and easements?- - ❑ Iii 0
re >30 ft_from downgradient curtain/foundation drains?- - El Q ID
Drainfield level and observation ports present - - 0 rib ❑
Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfeld?- ❑
IP El
Pump tank setbacks consistent with septic tank?- - ❑ N/A IA YES ❑ NO
• Pump tank size 1250 qal Manufacturer Snyder
z - El ill El
• acx�ss riser(s)and accessible from surface?-
0. Alarm or Control Panel Installed?- - 0 lif 0
Control Panel equipped with Timer/ETM I Counter- - 0 Q 0
a Pump installed in ❑ Bucket or NI On Block or ❑ Other
§ Pump Make/Model Zoeller N152
® Floats or 0 Transducer
a. Tank draw down 2 in/min Pumpcapacity 50 3
a Pa�Y qpm Squirt Height ft
Pump on time —1 min 10sec Pump off time 4 hrs 360
Daily flow set at qpd
Updated 12/7201S
- .MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# 321275400129
RECORD DRAWING
❑ Drairrfield&tIre,dkAd
orientation&layout
widimenslons for
re-location.
❑ TrendUbed
dimensions and
critical distances
within layout
❑ Septic/piano tank
placement
❑ Location of buildings
existing/proposed
❑ Observation ports,
dean-out locations,
&manifolds/d-boxes
❑ Location of wells,
surface water,roads,
&waterines_
❑ Reserve area(s)
0 North Arrow
if the designer or installer feel the need for additional information/comrnents,it may be attached.
Record drawing may also be on a separate page attached. No.Pages Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
1 certify that 1 installed the system in accordance with I cenrTy 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 esigner shown here have been cleared/appnaved by both
and Mason County Public Health and me ll 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 tained on this I further certify that all information contained on this
form and hid Record is accurate. form and attached Re•• • D -wing is accurate.
1/23/23 °" -.
afore oft ller Date r.4 J,r i!l'`(1 1 I1.3(,.
Sam Hyatt ` :`III
z.
/v,• a.ti,,,�•ti f
Printed Name of Slgnee ; i N_ ^ �:cl fl
/e: a.� f
i y A. •.. ' ' ''a
MASON COUNTY PUBLIC HEALTH /tip!• J `-zfI
.0�' 5100412 f0
The undersigned approves this Installation Report and 1.�. ADAM J.HUNTER f
Rec
og on behalf of Mason County rd LgSli;flft f f
txi'itt.s oA l21,,...- 't
/6Fezoz)
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 Updated 12J7/2015
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