HomeMy WebLinkAboutSWG2025-00225 - SWG As-Built - 10/27/2025 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2025-00225 Assessor Parcel # 320357500110
Applicant Name JUILANN BURNS Subdivision (Name/Div/Block/Lot)
Applicant Address 1010 SE PHILLIPS RD
City, State, Zip SHELTON, WA 98584 Installer Name GOLDY SEPTIC
Site Address 1012 SE PHILLIPS RD Designer Name ADAM HUNTER
INSTALLATION CHECKLIST
❑✓ Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair
System Type SHALLOW PRESSURE TRENCHES treatment Type N/A
>5 ft. from foundation? -- El N/A El YES ❑ NO
� - V_Vrci- - - ❑ ❑� ❑>50 ft. from wells.
Y >50 ft. from surface water? - �Q�.�3 •
- .- -- ❑ ❑� ❑
z 6
Cleanout between building and tank? - ❑ ❑� ❑
U Tank baffles present? - - - - - ❑ ❑✓ ❑
d24" access risers over each compartment. -�y - - - CICI0
W Effluent filter installed?- - ❑ 0 ❑
N 1250 HOUSE BROTHERS
Septic tank size gal Manufacturer
0 D-box water level and speed levelers used? - - El N/A El YES ❑ NO
DO Manifold/D-box accessible from surface?- - CI El CI
03E Check valves installed? - - ❑ ❑✓ ❑
(112 Transport Line Size 2 40
Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑✓ 3 ❑4 ❑ 5 ❑6
>10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO
0 >100 ft. from wells? - - ❑ ❑✓ ❑
W >100 ft. from surface water? - - CI ❑✓ CI
Er_ >10 ft. from potable water lines?- - ❑ 0 ❑
z > 5 ft. from property lines and easements?- - ❑ 0 ❑
Q
C > 30 ft.from downgradient curtain/foundation drains? - - ❑ 0 ❑
0
Drainfield level and observation ports present - - ❑ ❑� ❑
❑ Graveless chambers or ❑✓ Clean gravel used? (check one)
Proper cover installed over drainfield?- - El ❑✓ ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A 0 YES ❑ NO
• Pump tank size 1250 gal Manufacturer HOUSE BROTHERS
< 24" access riser(s)and accessible from surface?- - ❑ ❑✓ ❑
~
a Alarm or Control Panel Installed? - - CICI CI
2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑✓ El
m
n- Pump installed in ❑ Bucket or On Block or ❑ Other
a' Pump Make/Model ZOELLER N152 ❑ Floats or ❑ Transducer
a Tank draw down 2.2 in/min Pump capacity 53 gpm Squirt Height 6 ft
Pump on time 1.13min Pump off time 4hrs Daily flow set at 360 qpm
revised 1/22/2014
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
❑ Drainfield&
manifold orientation
&layout
Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
placement
O Location of
buildings
❑ Observation ports&
clean-out locations
❑ Location of wells,
surface water,&
roads
❑ Undisturbed native
soil between
trenches
O 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 1
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
I certify that 1 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 a .'a tac -\Record Drawing is accurate. form and attached Record Drawing is accurate.
10/17/25
Sigo. : •of - ' Date
J . ' GOLDY 10/17/25
Printed Name of Signee Ysz.
tic
Vo :9�,
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and :.'„i ,r.
Record Drawing on behalf of Mason County Public �, ,, .
ADAMJ.HUNTER
Health: susa�zaa, ti:
CRITIONCO(Y1 1°i' l IUC--
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
rev.sed 1'2212014
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