HomeMy WebLinkAboutSWG2022-00199 - SWG As-Built - 11/14/2023 • ''rtl
RECORD DRAWING (ASBUILT) pg. 1 0G1 t 7 202 _ ASON COUNTY PUBLIC HEALTH
PARC IlrYcrION I
Permit Number SWG 2022-00199 Assessor Parcel # 321275100244
Applicant Name BRENDA BAKKEN Subdivision (Name/Div/Block/Lot)
Applicant Address 221 E BALLANTRAE DR LAKE LIMERICK DIV 2 LOT 244
City, State, Zip SHELTON, WA, 98584 Installer Name JAKE GOLDY
Site Address 71 E CONNEMARA WAY Designer Name ADAM HUNTER
INSTALLATION CHECKLIST
0 Full System Installation 0 Septic Tank Only 0 Drainfield Only 0 Repair
System Type DRIP D INFtELo Pretreatment Type NUWATER BNR-500
>5 ft, from foundation? - - 0 NIA 0 YES 0 NO
>50 ft.from wells? - ❑ 0 ❑
Z• >50 ft. from surface water? - - ❑ 0 0
F Cleanout between building and tank? 0 0 0
a Tank baffles present? - - - 0 0 Cl
a24" access risers over each compartment?- - ❑ 00
W Effluent filter installed? ('"� ❑ ❑✓
0 1200 INFILTRATOR
Septic tank size gal Manufacturer
O D-box water level and speed levelers used? - - 9 N/A 0 YES 0 NO
gO Manifold/D-box accessible from surface?- - 0 ❑ ❑
CE Check valves installed? - - El 0 0
2 Transport Line Size 1 /Schedule/Class SCH40
Bedrooms installed (check one) 0 2 pH'3 ❑4 El ❑6
' `>10 ft. from foundation? 0 NIA El YES ❑ NO
G >100 ft. from wells? - 0 ❑ 0
W >100 ft. from surface water? - - 0 ❑ 0
it >10 ft. from potable water lines?- ❑ 0 0
Z > 5 ft from properly lines and easements?- - 0 ❑ ❑
K > 30 ft.from downgradient curtain/foundation drains? 0 0 0
o
Drainfield level and observation ports present 0 0 0
❑ Graveless chambers or 0 Clean gravel used? (check one) drip
Proper cover installed over drainfield?- Cl 0 ❑
Pump tank setbacks consistent with septic tank? - ❑ N/A 0 YES 0 NO
• Pump tank size 1200 INFILTRATOR
gal Manufacturer
< 24"access riser(s)and accessible from surface? ❑ ID ❑
~ Alarm or Control Panel Installed? - 0 0 ❑
0
2 Control Panel equipped with Timer/ETM/Counter - 0 0 ❑
7
Cl- Pump installed in 0 Bucket or 0 On Block or ❑ Other
fL 1/2HP AYMCDONALD - M22 ❑ Transducer
Pump Make/Model El Floats or
2
0_ Tank draw down 0.4 in/min Pump capacity 10 gpm Squirt Height N/A ft
Pump on time 3MIN Pump off time 2HR5 Daily flow set at 360 gpm
revised u2212014
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
O Drainfield&
manifold orientation
&layout
O Trench/bed
dimensions and
critical distances
within layout
SEE ATTACHED
O septic/pump tank
placement
O Location of
buildings
❑✓ Observation ports&
clean-out locations
• Location of wells,
surface water.&
roads
O Undisturbed native
soil between
trenches
O North Arrow
If the designer or installer feel the need for additional information/comments, it may be attached. 1
Record drawing may also be on a seperate 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 that all information contained on this I further certify that all information contained on this
fo and a ached Recwi is accurate. form and attached Record Drawing is accurate.
10/24/23
Signature of Installer Date
JAKE GOLDY 10/24/23
Printed Name of Signee ' r}'�:
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and r.G
Record Drawing on behalf of Mason County Public } 1T
Health: \p yy\0"eln
k '-t( LT ''
Signature of Environme 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
rev rued 1:221' 2014
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