HomeMy WebLinkAboutSWG2025-00016 - SWG As-Built - 5/7/2025 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2025-00016 Assessor Parcel # 320234700120
Applicant Name scott johnson Subdivision (Name/Div/Block/Lot)
Applicant Address 8639 salty dr nw
City, State, Zip olympia wa 98502 Installer Name scott jnhncnn
Site Address 3803 arcadia rd shelton wa 98584 Designer Name Adam Hunter
INSTALLATION CHECKLIST
Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type Oscar X02 Pretreatment Type X02
>5 ft. from foundation? - - ❑ N/A Ig YES ❑ NO
>50 ft. from wells? - IECIIIWU ❑ IX ❑
• >50 ft. from surface water? - - ' IllPA ElZ
FQ- Cleanout between building and tank? -- - -MAY- 0 5-2125 -- , ❑ ❑
U Tank baffles present? - - - ❑ A. ❑
H 24"access risers over each compartment?-By - ❑ g ❑
Lail Effluent filter installed?- - A ❑ ❑
1200
Septic tank size gal Manufacturer hagerman precast
d D-box water level and speed levelers used? - - M N/A ❑YES ❑ NO
oO Manifold/D-box accessible from surface?- - ® ❑ El
oat Check valves installed? - - 14 ❑ ❑
oa
E Transport Line Size 1 Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑3 VI 4 ❑ 5 ❑6
>10 ft. from foundation?- - ❑ N/A OYES ❑ NO
>100 ft. from wells?- - ❑ lir ❑
--1 >100 ft. from surface water? - - ❑ I ❑
u. >10 ft. from potable water lines?- - ❑ Dif ❑
> 5 ft. from property lines and easements?- - ❑ N ❑
DE > 30 ft. from downgradient curtain/foundation drains? - - - ❑ [I ❑
Drainfield level and observation ports present - - ❑ '1 ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ a] ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A tki YES ❑ NO
`-L Pump tank size 1200 gal Manufacturer hagerman precast
Q 24"access riser(s) and accessible from surface?- - ❑ ❑
t—
a Alarm or Control Panel Installed? - - ❑ I ❑
2 Control Panel equipped with Timer/ETM/Counter- - ❑ V ❑
n- Pump installed in Ig Bucket or ❑ On Block or ❑ Other
Pump Make/Model A.Y. mcdonald 'Floats or ❑ Transducer
a Tank draw down NA in/min Pump capacity 30 gpm Squirt Height NA ft
Pump on time X02 Pump off time X02 Daily flow set at 480 gpm
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
Drainfield&
manifold orientation
&layout
0 Trench/bed
dimensions and
critical distances
within layout
LI Septic/pump tank
placement
Location of
buildings
Observation ports&
clean-out locations
Location of wells,
surface water,&
roads
0 Undisturbed native
soil between
trenches
ri 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
I further certify that all information contained on this I further certify that all information contained on this
form and attached Record ing is accurate. form and attached Record Drawing is accurate.
4/28/25 oft
Signature of Installer Dateor, ,• +1 j►/
Scott Johnson .h:
Printed Name of Signee ~' , W
ice•..
MASON COUNTY PUBLIC HEALTH Air � sn.1
X:
The undersigned approves this Installation Report and 51UU�12
Q:: ADAMA J.HUNTER .y
Record Drawingon behalf of Mason CountyPublic LECt'"s�"dtst'S'�`tt 1
MA& ♦�IAMIN .�� 1� d,
„. '• I, I:•, togHealth:
or, g
Signature of Environment Al 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 1 n^M^
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