HomeMy WebLinkAboutSWG2020-00657 - SWG As-Built - 10/23/2023 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2020-00657 Assessor Parcel # 320215302037
Applicant Name TRACEY MCGLOTHLIN Subdivision (Name/Div/Block/Lot)
Applicant Address PO BOX 1370 LOT 37 SHORECREST ADD BLK 2
City, State, Zip SHELTON, WA 98584 Installer Name GOLDY SEPTIC SVC
Site Address 201 E MIDWAY LN Designer Name JIM HUNTER
INSTALLATION CHECKLIST
0 Full System Installation 0 Septic Tank Only 0 Drainfield Only 0 Repair
System Type GRAVITY Pretreatment Type N/A
>5 ft.from foundation? - - 0 N/A 0 YES 0 NO
>50 ft.from wells? - 0 0 0
2 >50 ft.from surface water? - - ❑ 0 0
HCleanout between building and tank? - - 0 0 0
a Tank baffles present? - - ❑ 0 0
a 24"access risers over each compartment? „r�-z - 0 0 0
LU Effluent filter installed?- 0 0
co 1200 HAGERIZN PRECAST
Septic tank size gal :Manufacturer
O D-box water level and speed levelers used? - 0 N/A 0 YES 0 NO
DJ
O Manifold/D-box accessible from surface?- El0 0
u.
OQCheck valves installed? - - 0 0 0
f Transport Line Size 4 Schedule/Class SEWER
Bedrooms installed (check one) 0 2 0 3 ❑4 0 5 ❑6
>10 ft. from foundation? - ❑ N/A ❑✓ YES ❑ NO
ci >100 ft. from wells?- • 0 0 0
W >100 ft. from surface water? - - 0 0 0
it >10 ft.from potable water lines?- - 0 0 0
Z- > 5 ft. from property lines and easements?- - 0 0 0
d > 30 ft.from downgradient curtain/foundation drains? - - 0 0 0
• Drainfield level and observation ports present - - 0 0 0
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield? 0 0 0
Pump tank setbacks consistent with septic tank? - - 0 N/A 0 YES 0 NO
Pump tank size N/A gal Manufacturer N/A
Q 24"access riser(s)and accessible from surface? 0 0 0
EL
a Alarm or Control Panel Installed? - - 0 0 0
• Control Panel equipped with Timer/ETM/Counter- 0 0 0
7 N/A
a Pump installed in 0 Bucket or 0 On Block or 0 Other
a• Pump Make/Model N/A 0 Floats or 0 Transducer
y Tank draw down N/A in/min Pump capacity N/A gpm Squirt Height N/A ft
Pump on time N/A Pump off time N/A Daily flow set at N/A gpm
reused lrz120/4
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
❑ Drainfield&
manifold orientation
&layout
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank SEE ATTACHED
placement
❑ Location of
buildings
❑ Observation ports&
clean-out locations
❑ Location of wells,
surface water,&
roads
❑ Undisturbed native
soil between
trenches
ElNorth 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
1 certify that 1 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 inform-lion contained on this I further certify that all information contained on this
form a d attached Record�: ng is accurate. form and attached Record Drawing is accurate.
/ 9/1/23
Sig of l;. alter Date
JA !•LD
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH ` 0 0
The undersigned approves this Installation Report and d"'_
Record Drawing on behalf of Mason County Public , o
i
Health: /�
V—t-Q �1,(',r)a.1 ( o its I .3
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
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