HomeMy WebLinkAboutSWG2023-00384 - SWG As-Built - 12/19/2025 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2023-00384 Assessor Parcel #
32136-21-00150
Applicant Name Brian Hardie Subdivision (Name/Div/Block/Lot)
Applicant Address 40 E Squirrel Tree Ct
City, State, Zip Shelton WA 98584 Installer Name Scott Johnson
Site Address 40 E Squirrel Tree Ct Designer Name NA Tank replacement
INSTALLATION CHECKLIST
❑ Full System Installation Septic Tank Only ❑ Drainfield Only ❑ Repair
I System Type Pump to gravity eatment Type N/A
>5 ft. from foundation'? IESEgil - ❑ WA 0 YES ❑ No
>50 ft. from wells? - ❑ 0 ❑
Z >50 ft. from surface water? -DEC- a'-2-D25 - N�- El
I--
Q El
between building and tank? ❑
U Tank baffles present? - By L .
- ❑ El ❑
H 24" access risers over each compartm ❑ V ❑
a
W Effluent filter installed?- -- - ❑ B LI
cn
1250 HAGERMAN PRE-CAST
Septic tank size gal Manufacturer
® D-box water level and speed levelers used? - - ❑ N/A AYES ❑ NO
-' ❑ gr. ElO Manifold/D-box accessible from surface?- -
002 Check valves installed? - - V ❑ ❑
oa 4" 3034
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑ 5 ❑o
>10 ft.from foundation?- - ❑ N/A ® YES ❑ NO
O >100 ft. from wells?- -- - ❑ 0 ❑
W
❑
>100 ft. from surface water? - ❑ B
Ls, >10 ft. from potable water lines?- -- - - - - ❑ ® ❑
Zd > 5 ft. from property lines and easements?- - ❑ 0 ❑
d > 30 ft. from downgradient curtain/foundation drains? - - ❑ Q ❑
• Drainfield level and observation ports present - - ❑ Q ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistant with septic tank?- - ❑ N/A 0 YES ❑ NO
• Pump tank size 1250 gal Manufacturer HAGERMAN PRE-CAST
z 24" access riser(s) and accessible from surface?- - ❑ 0 ❑
H
a Alarm or Control Panel Installed? - - El El
2 Control Panel equipped with Timer/ETM /Counter- - Q ❑ ❑
a- Pump installed in ❑ Bucket or Q On Block or ❑ Other
n' Pump Make/Model
2 Liberty LP250 Q Floats or ❑ Transducer
Tank draw down N/A in/min Pump capacity 50 gpm Squirt Height
Gravity ft
a. Gravity
On float demand off time On float demand Daily flow set at gpm
Pump on time Pump
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
Drainfield&
manifold orientation
&layout
El Trench/bed
dimensions and
critical distances
within layout
Septic/pump tank
placement
Location of installed as per design
buildings
Observation ports&
clean-out locations
Location of wells,
surface water,&
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.
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 attac ed R rd Drawing is accurate. form and attached Record Drawing is accurate.
12/17/2025
Signature of Installer Date
Scott Johnson
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
QINj/lAC
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
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