HomeMy WebLinkAboutSWG2023-00003 - SWG As-Built - 12/1/2023r
RECORD.DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SwG 2023-00003 Assessor Parcel # 320291300370
Applicant Name Amanda Robinson Subdivision (Name/Div/Block/Lot)
Applicant Address 580 SE Arcadia Rd
City, State, Zip Shelton, WA 98584 Installer Name Bo Russell
Site Address 580 SE Arcadia Rd Designer Name Adam Hunter
INSTALLATION CHECKLIST
0 Full System Installation ® Septic Tank Only ❑ Drainfield Only 0 Repair
System Type Tank replacement& lift station Pretreatment Type None
>5 ft.from foundation? - -- ❑ N/A lil YES ❑ NO
>50 ft.from wells? - - 0 ® 0
Z• >50 ft.from surface water? - -- El ® El
HCleanout between building and tank? - - El WI
U Tank baffles present? - -- ❑ lil ❑
a 24" access risers over each compartment?-LID 2 8 2.(123 - ❑ El
W Effluent filter installed?- - 0 lJ 0
`" 1200 Norwesco
Septic tank size gal Manufacturer
o D-box water level and speed levelers used? - - N/A El YES El NO
>4O Manifold/D-box accessible from surface?- - 1J ❑ 0
mZ Check valves installed? - •- LE 0 ❑
GQ
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6
>10 ft.from foundation?- •- Ill N/A ❑ YES ❑ NO
O >100 ft. from wells?- - ❑✓ ❑ ❑
W >100 ft. from surface water? - - ❑� El El
li >10 ft. from potable water lines?- - Ill ❑ ❑
Z- > 5 ft. from property lines and easements?- - Q ❑ ❑
Q
Q > 30 ft. from downgradient curtain/foundation drains? - - WI El El
Drainfield level and observation ports present - - I1 ❑ ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑ ❑
Pump tank setbacks consistant with septic tank?- •- 0 N/A ® YES 0 NO
• Pump tank size 1060 gal Manufacturer Infiltrator
Q 24" access riser(s) and accessible from surface?- - ❑ Eil ❑
H
a Alarm or Control Panel Installed? - - El lil ❑
• Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ 111
D
d Pump installed in ❑ Bucket or 0 On Block or 0 Other
O.• Pump Make/Model Zoeller N270 ® Floats or El Transducer
d Tank draw down Demand in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at qpm
revised 1'2212C14
/
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
El Drainfield&
manifold orientation
&layout
▪ Trench/bed
dimensions and
critical distances
within layout
• Septic/pump tank
placement
❑ Location of
buildings
❑ Observation ports&
clean-out locations
❑ Location of wells,
surface water,&
roads
▪ Undisturbed native
soil between
trenches
▪ North Arrow
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
1 further certify that all information contained on this I further certify that all information contained on this
form and attached Recordrd Drawing is accurate. form and attached Record Drawing is accurate.
�9 A` 44,SSea 11/22/23 di 1 I ti 2 `3
Signature of Installer Date
•Bo Russell ``' '�
Printed Name of Signee tiu:' %v v.•,,, c4
MASON COUNTY PUBLIC HEALTH •'' 4*, ' s,
,'41
The undersigned approves this Installation Report and • 91o0:i2
Record Drawing on behalf of Mason County Public o`•: ADAM J.MINTER
•.,
Health: � ~s-`
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
revised 1/22/2014
.. - 1330'
to
m
m
s J D•
m 0 n
•DRAI►NHGE_ / -,v
II
8 Ma
Lit____ ❑
w
V
O ® 00000it0n 000 ki
d
o n m c cn X D X X X X X -k^�`�
O A "U CO 1 m 1 1 1 -II 5jI
O , 0,ZC , *r p , m
1 '
r
Q—
•
lA c 1 > Zlm = mN.) A r- Wn < r mn m > Z r O O 3 O -I ' Qv -Iz DO r 'z r0 m-1 O -m v, „, c� D 1m O A D1 m D D no D n !
l 1 ...
om v o m
0 c0 mD O
ZZ Z O = Zm
C
m r
-NSNNi ............ 7%,
Z C
4411111
r � �
v SII
n.3 we
o
xi
m I�
1 _ DRAINgGE
to __,.
m g' 7
J
D C r
V � iti
m .� b cn
o 0
r
Z
m
03
T•
r
O
O
Z
D
O
m
v
v
m
y
Z 0 I-I V!z a• ,;
0 D `-•4 •
-
= O 3 •• .� .-
rwi 0 z Z n •:.�;.
^' D
o D N 0 O ,` \
W D � W
0 0 - ° wa, o—i 0 - 3 71
D Z 5 N Z
o 0 w r, rn O lTJ mrn
Ti
O o �i rri
Z7 C N
Z D > —I0 V O r
o Ib V) c C
O - CNV
Jo rn
2
C7
v� „ I_^ Z A n0
m Z m 5pZ
* r o D V. m D
O m 0 17
m D m -I z O
w N x A
* S ' C
o A m -1
ro 'a O 2p
;O� w > r.,'
2
w