HomeMy WebLinkAboutSWG2022-00339 - SWG As-Built - 10/19/2023 R
jet ' OCT 1 12023
•RECORD DRAWING (ASBUILT) pg. 1 RECEIVM211SO COUNTY PUBLIC HEALTH
PARCEL IDE 1trrl.AI lUWW
Permit Number SWG 2022-00339 Assessor Parcel # 42333-51-03011
Applicant Name MICHAEL ENGLISH Subdivision (Name/Div/Block/Lot)
Applicant Address 4280 N LAKE CUSHMAN RD
City, State, Zip
HOODSPORT, WA, Installer Name OWNER
Site Address 4280 N LAKE CUSHMAN RD Designer Name ADAM HUNTER
INSTALLATION CHECKLIST
0 Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type SIMPLE PRESSURE Pretreatment Type N/A
>5 ft. from foundation? - - ❑ N/A ❑✓ YES ❑ NO
>50 ft. from wells? - - 0 0 0
Z >50 ft.from surface water? - - 0 0 0
•
H Cleanout between building and tank? - - - El 0 0
U Tank baffles present? - \JG} 0 0 ❑
d 24"access risers over each compartment? 1`��' - 0 00
W Effluent filter installed?- HA6ER<MAV 0 0
Septic tank size 1250 gal Manufacturer
aD-box water level and speed levelers used? - - 0 NIA ❑YES ❑ NO
❑
OO Manifold/D-box accessible from surface?- - 0 ❑
m- Check valves installed? - - 0 0 0
CC 2 40
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) 0 2 0 3 ❑4 ❑ 5 ❑6
>10 ft.from foundation? - ❑ N/A ❑✓ YES ❑ NO
CI >100 ft. from wells? - A �t� � 1(f - - - ❑ 0 0
W >100 ft. from surface water? - - Y ❑ 0 ❑
rz >10ft. from potable water lines - - - OCT-1-9- 2023- - - - 0 0 0
Z > 5 ft.from property lines and e9kii1i1eM y r 3'- - - 0 0 0
P P Y atirlilhiii6? _z'. - ✓
> 30 ft. from downgradient curtainlfoundation �i7Ls' 0 ❑ 0
Drainfield level and observation ports present - kM1M1 - 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
1250 HAGERMAN
Pump tank size gal Manufacturer
Q24"access riser(s)and accessible from surface?- - ❑ 0 ❑
~ Alarm or Control Panel Installed? - - 0 0 0
a f Control Panel equipped with Timer/ ETM /Counter-
El 0 ❑
4 Pump installed in 0 Bucket or ❑✓ On Block or El Other
fLIBERTY 290 ❑ Floats orTransducer
Pump Make/Model 0
it Tank draw down 1.2 in/min Pump capacity 30 gpm Squirt Height 2
a ft
2 MIN Pumpoff time 4 HRS Daily flow set at 360 gpm
Pump on time
�.�ue,rzvzara
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
▪ Drainfield 8
manifold orientation
&layout
0✓ Trench/bed
dimensions and
critical distances
within layout
O Septic/pump tank
placement
0 Location of
SEE ATTACHED
buildings
O Observation ports 8
clean-out locations
O Location of wells,
surface water.8 A
P PRO VE
roads
O Undisturbed native
OCj soil between ( 9 2023
trenches (ifa•loh
COUNTYEi<AR2 IIE ,_
0 North Arrow �N�o �;AiuNLih
If the designer or installer feel the need for additional information/comments, it may be attached.
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
l further ce that all i formation c ntained on this I further certify that all information contained on this
rm and a ac d Rec-)r Drawin is ccurate, form and attached Record Drawing is accurate.
10/6/23
Signature of Installer Date
MICHAEL ENGLISH I
10/6/23
Printed Name of Signee
_ It Fhe
MASON COUNTY PUBLIC HEALTH B,
The undersigned approves this Installation Report and
Re rd Drawing on behalf of Mason County Public
ea/
Si atur nvironmental 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¢ed 1122t2014
a
A -
n o ,
,c $
. ' — o
6J \
CA
,0
A
0 PI O �\ D
T
n
Ul
b
\ m
\ r
D.
cc
m
F.
'n
z
0
0
IM
A NN
h \%
If'- " � �yy 0 71
o
N .C$» � Y ,y 0 1 m 1 . a
p
0) 3ap15'IaOL 1-
co
0
��
rzo- A i o
z
co m
rn y A rn z
> s y
H
z
0 0
m
z
0
c
—1
co
Xi
0 m
F n ,_
z 0
A y4
• rn
m > c m
O o
a '2 0 -
0 > 0, "� T Z -1 -1 m
a Z H
o
C m(/)mO r n2m OS 1 z? hh r-mD 0
8 Pi in
mO
cn
cn
0
co
no
-<
C. :c _n
CD^ NI o o W _, mIzis , o n * mCpo z o I nn oc w Cm
MI rZ1 V g w rn
O m N
A 0n
3 s n
m o < DJ m m
a
-4m mm \_� i T
% 4 V 0 N
6 6M FT A o
a
IA
AV
26304 t rl P
u
(» et @ ,O, C,) ® O JT
9N) 0 -ocou o 9
putt AA A A A AA
O O O O O O O O O
A A A A A - 8 '
p 9' O O O O O O O N N - o o
v v v - y
O m o io o - �.-_._ .....
n
O n O O O O O O O O m
D 2 A CO H N A mm •W
< H 9 A1 W mA m r m
9 orn
n o 0 o F A
o m n i H y n o o;/ � �
3
N A Z y :—
z
Z
A o ° o D m $ (� �i
c m - _
A
A C N
co A (l
O D
m < m
m
m 2 Q
Z
O
A
O �
< O
n
/
I
A I
S T
O .
O
Z V
O
H
S
p
co
o
Ja~
_
4`-his'- i r,
ox
ZF y
Hu n m 0 - o rail o
mm m D O m n ET, Z (P
maFo > y 0 My W
AO _ O
3 n X Z r O
AD D o
°o m < o y N. O --I
M
0o n pc ° n m _.
mA A a < S W•
DZ iOa `
T wJ
m0 D glQ .AOM
0R
Amm
40 T ma - D r" 5uJ
-o A tii 2
-to Z vuO ` z T 0) A y0
m 0 OOO -' D a z O (7 ; F 'rw
TA y gi
On D - _ up m m in r Z
~, ~ _ O 0m
<
mF m
O o o _
ZOAAA nA ZAD; m mOO4 - S m mg If A [I* O A oD VI ' r S L Amm
O Z O H
? ? F F E.Z . > o �f f goyr rt c.
pC z Y i "�' F , ° ° °i o
D o< n Z A o I N ° tz sp i F y pc o o
co
01
AF Z mooeo - c ~u z n1 r n1 D S t � i m xA oZ m0A p Q Alm ° o n � / 44 n
a D II A
✓, a -
z ems]
Iate' I _.._...._