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HomeMy WebLinkAboutSWG2023-00093 - SWG As-Built - 10/16/2023 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number Sw0 2023-00093 Assessor Parcel # 320323300090 Applicant Name NICHOLSON PROPERTIES LLC Subdivision (Name/Div/Block/Lot) Applicant Address 1802 BLACK LAKE BLVD City, State, Zip OLYMPIA, WA 98512 Installer Name GOLDY EXCAVATING Site Address 401 w GOLDEN PHEASANT RD,SHELTON Designer Name ADAM HUNTER INSTALLATION CHECKLIST ❑✓ Full System Installation ❑ Septic Tank Only ❑ Drainfield Only 0 Repair System Type OSCAR x02 Pretreatment Type X02 >5 ft.from foundation? - ❑ NIA ❑✓ YES 0 NO >50 ft. from wells? - - ❑ 0 0 Z >50 ft. from surface water? - - ❑ Q 0 HCleanout between building and tank? • ❑ 00 U Tank baffles present? - • "' - 0 0 0 a24" access risers over each compartment?. - y ❑ ❑✓ 0 W Effluent filter installed? l�'. ❑ 2 0 w 1200 HOUSE BROTHERS Septic tank size gal .." Manufacturer O D-box water level and speed levelers used? - - ❑� N/A ❑YES ❑ NO 00 Manifold/D-box accessible from surface?- - 00 ❑ mZ Check valves installed? - - ❑ 0 0 0< 1 40 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 0 2 03 ❑4 ❑ 5 0 6 >10 ft. from foundation?- ❑ N/A ❑✓ YES ❑ NO G >100 ft. from wells?- 0 0 ❑ W >100 ft. from surface water? - 0 20 y. >10 ft. from potable water lines?- - 0 ❑d ❑ Z• > 5 ft. from property lines and easements?- . ❑ ❑✓ ❑ K > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑ • Drainfield level and observation ports present - 0 0 0 ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- 0 0 0 Pump tank setbacks consistant with septic tank? 0 N/A ❑d YES 0 NO Pump tank size 1200 HOUSE BROTHERS gal Manufacturer Q24"access riser(s)and accessible from surface?- - 0 ❑✓ 0 H a Alarm or Control Panel Installed? - 0 0 0 2 Control Panel equipped with Timer/ ETM/ Counter- - 0 0 ❑ 7 d Pump installed in ❑ Bucket or ❑✓ On Block or 0 Other • Pump Make/Model AYMCDONALD SOGPM 0Floats or ❑ Transducer 2 PER OSCAR PER OSCAR PER OSCAR y• Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time PER OSCAR Pump off time PER OSCAR Daily flow set at PER OSCAR gpm remsed 1122/2014 • RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING ❑ Drainfield 8 manifold orientation 8 layout ❑ Trench/bed dimensions and critical distances within layout ❑ Septic/pump tank placement SEE ATTACHED ElLocation of buildings ❑ Observation pods 8 clean-out locations ❑ Location of wells, surface water,8 roads ❑ Undisturbed native soil between trenches El 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 1 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 1 further certify that all information contained on this for d attached Record Drawing is accurate, form and attached Record Drawing is accurate. \\y\\ 9/10/23 Signature of Ins Date I ctY--e— C. o1cS7 ( IJau-)) Printed Name of Signee _ _ 9/25/23 to MASON COUNTY PUBLIC HEALTH - .- t The undersigned approves this Installation Report and Si, ' Record Drawing on behalf of Mason County Public .1t • Health: 1�.lw1�0 � �! 1, 24 Signature of Environm 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 rerased 1/21@01g w / . GOLDEN R�PHEASANT \ — . /. \ 77/ 1111 w / , ( \ \� /� w© .. o / } { \ ;SE / , , ` : ) \ 1 ) % \ rn : - o ) _1 c } ` 0 • ) \• j - o rn ., - ; / ; ,® \ \ � � , y a y� \,, . xi -0 - 2 { / / \ ! - 0ujo \/ / \ \ \ - - < D { � 2 R $ 2 2 O \ E « m Co 1Z ,- X