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HomeMy WebLinkAboutSWG2023-00194 - SWG As-Built - 6/13/2024 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG2023-00194 Assessor Parcel# 320215603021 Applicant Name Tom Roth Subdivision (Name/Div/Block/Lot) ,/Gy Applicant Address 1537 NW Woodbine way O City, State, Zip Seattle,WA 98177 Installer Name DB& R Construction CSC 1 Site Address 380 E Wood Lane, Shelton Designer Name Beck Ric er INSTALLATION CHECKLIST x❑ Full System Installation ❑Tari Only ❑ Drainfeld Only ❑Repair ❑Other System Type Pressure Pretreatment Type ,5 ft from foundation? - - - - - - - - - - - - - - - - - - - - - - - -- -- ❑ NIA ®YES ❑ NO >50 ft.from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ x❑ ❑ Y >50ft.from surface water? - - - - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ Z HCleanout between building and tank? - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ p Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ x❑ ❑ IL 24"access risers over each compartment?- - - - - - - - - - - - - - - - ❑ 0 ❑ I W Effluent filter installed?- - - - - - - - - - - - - - - - - - - ❑ 0 ❑ N Septic tank size 1200 gal Manufacturer Sound Placement o D-boxwater level and speed levelers used? - - - - - - - - - - - - - - - © NIA ❑ YES ❑ No DJ O Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ © ❑ °7Z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ oa r Transport Line Size 2" Schedule/Class SCHD 40 Bedrooms installed (check one) ❑ 2 x❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA x❑ YES ❑ NO >100 ft. from wells?- - - - - - - - - - - - - -- - - - -- - - - - - - - - - ❑ ® ❑ W >100 ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑x ❑ LL >10 ft. from potable water lines?- - - - -- - - - - - - - - - - - - - - - ❑ 0 ❑ Z > 5ft.from property lines and easements?- - - - - - - - - - - - - - - - ❑ ❑ Q O > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ 0 ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑x ❑ ❑ Graveless chambers or x❑ Clean gravel used? (check one) Proper cover installed overdrainfield?- - - - - - - - - - - - - - - - - - - ❑ ❑x ❑ Pump tank setbacks consistent with septic tank?- - -- - - - - - - - - - ❑ NIA ❑x YES ❑ NO Y Pump tank size '200 gal Manufacturer Sound Placement Q24'access riser(s) and accessible from surface?- - - - - - - - - - - - - ❑ © ❑ ~ Alarm or Control Panel Installed. ❑ © ❑ L Control Panel equipped with Timer/ETM/Counter- - - - - - - - - -- ❑ © ❑ _a Pump installed in ❑ Bucket or ® On Block or ❑ Other a Pump Make/Model Goulds PE 51 0 Floats or ❑ Transducer f a Tank draw down 2 in/min Pump capacity 48 gpm Squirt Height 5 ft Pump on time 1.25 min Pump off time 4 hrs Daily flow set at K60 gpd updatadlavmu MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# 320215603021 RECORD DRAWING Q Drainfield&manifold orientation&layout w1dimeneons for re-location. 0 Trench/bed dimensions and critical distance , within layout ® Septidpump tank placement x Location of buildings existinglproposetl ❑K observation ports, clean-out locations. &manifoltlsld boxes X❑ Location of wells, surface water.round &waterlines. O Resa,e aresco Q Norm Arrow If the designer or installer feel the need for additional inform atioNcomments, it may be attached. Record drawing may also be on a separate 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 1 further certify that all information contained on this form and attached Record Drawing is accurate form and attached Record Drawing is accurate. Dave Young 02.05.2024 Signature of Installer Date Dave Young a Printed Name of Stones MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Ref( and or e 1-". /[� BeckyJ Rieger Record Drawing on behalf of Mason Oourzly Pub c' 3 btlr It Health 6/�, �ZGZ'�f �,6 02-05.2024 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 oli iv712o15 X n � 9 z m R� x m ti o x � � � � N fcnxxwnr avvo G C m m m 3 O m x m m m 0 N m O m N X G D 0x N m ~ mm Z '.m0 < N 3 Z N m T m m 00 ➢ � o mp Am A 00 DO m m3 D O O dIM LILU m O O Z m 3N1�J.lii3dOild m O n z G) � � z � � m � ➢A � � D � � z 1cp� 3 O fn � 11 � x1 � c /mom » < 3 a m o mA y M. 00 D 00 y Z ➢ ♦ / n � � c O o ➢ � 0 �� Nm ATD O SNO _ {p pQ• ti 0 3 � 00 �" m� MzRN AS,...9 AN Om rOm mNm f Od � • Se � O o"el '. .. CJNNAC �J VIA AOAZ ��. 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