HomeMy WebLinkAboutSWG2023-00402 - SWG As-Built - 10/2/2024 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2023-00402 Assessor Parcel# 620181400020
Applicant Name JENNIFER WEXLER Subdivision (Name/Div/Block/Lot)
Applicant Address 430 HOMER ADAMS RD
City, State,Zip ELMA,WA 98541 Installer Name JAKE GOLDY
Site Address 430 HOMER ADAMS RD Designer Name ADAM HUNTER
INSTALLATION CHECKLIST
❑✓ Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type SAND LINED BED Pretreatment Type WA
>5 ft.from foundation? - - ❑WA YES ❑ No
>50 ft.from wells? -- -- - ------ ---- ------- - ------ ❑ 0 ❑
Y >50 ft.from surface water? -- -- - ----------- - ------- ❑ ❑✓ ❑
FCleanout between building and tank? ------------------- ❑ ❑ ❑
O Tank baffles present? ------- - - - ---- --- -- -- - - - - - - ❑ ❑
1— 24"access risers over each compartment?------- -- --- -- -- ❑ ❑
0-
W Effluent filter installed?- - - ------ - ---- --- --- El
1200 HOUSEYROTHER�
Septic tank size gal Manufacturer
0 D-box water level and speed levelers used? --- - ----------- ❑O NIA ❑YES ❑ NO
�J
00 Manifold/D-box accessible from surface?------ - ---------- ❑ ❑
o?Z Check valves installed? ------------ -------------- ❑
02 Transport Line Size 2 Schedule/Class 40
Bedrooms installed(check one) ❑ 2 ❑✓ 3 ❑4 ❑5 ❑6
>10 ft.from foundation?----- ------ - -- ---------- -- ❑ WA ❑✓ YES ❑ No
0 >100 ft.from wells?-- -- ------ ---- -- ---- --------- ❑ ❑✓ ❑
w >100 ft.from surface water?------------------------ ❑ El
LL >10 ft.from potable water lines?---------------------- ❑ ❑� ❑
Z >5ft.from property lines and easements?---- -- - -- ------- ❑ ❑� ❑
0: > 30 ft.from downgradient curtain/foundation drains?- - -------- ❑ ❑� ❑
0 Drainfield level and observation ports present - ---- --------- ❑ ❑ ❑
❑ Greveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?---------- ------- -- ❑ ❑� ❑
Pump tank setbacks wnsistant with septic tank?---- --------- ❑ WA ❑J YES ❑ NO
Y Pump tank size 1200 gal Manufacturer
HOUSE BROTHERS
Q 24"access riser(s)and accessible from surface?-- -- --------- ❑ [a ❑
~ Alarm or Control Panel Installed? ❑ ❑ Eld ❑ ❑ ❑
� Control Panel equipped with Timer/ETM/Counter------ - ----
7
a Pump installed in ❑✓ Bucket or ❑ On Block or ❑ Other
CIL Pump Make/Model ZOELLER N152 ❑✓ Floats or ❑ Transducer
=a Tank draw down 2 INIMIN in/min Pump capacity 50 stpm Squirt Height 2'4 ft
Pump on time 12MIN Pump off time 4HRS Daily flow set at So gpm
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RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
❑ Drainfield It
manRuld orientation
8 layout
TrencN➢ad
dimensions and
critical distances
within layout
Sepocipump tank
Placement
Location of SEE ATTACHED
buildings
Observation Ports&
cleanout locations
rl 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 tlrawing may also be on a separate page attached. No. Pages Attached 1
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 hem have been cleared'spproved 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
l further certify that all information contained on this I further certify that all information contained on this
lnached Rec:Ewing is accurate. form and attached Record Drawing is accurate.
10/1/24
Signature of Installer Date
JAKE GOLDY
Printed Name of Sign" 1 0/2(24
MASON COUNTY PUBLIC HEALTH ,.. ^
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public i t
Health
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Signature of Envlmn 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
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