HomeMy WebLinkAboutSWG2024-00085 - SWG As-Built - 11/19/2025 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Permit Number SWG 2024-00085 Assessor Parcel # 620181400010
Applicant Name Charles Drummond Subdivision (Name/Div/Block/Lot)
Applicant Address 410 W Homer Adams Rd
City, State, Zip Elma, WA 98541 Installer Name Goldy Excavating
Site Address 410 W Homer Adams Rd Designer Name Adam Hunter
INSTALLATION CHECKLIST
0 Full System Installation ❑ Septic Tank Onl �� • infield Only 0 Repair
System Type pressure trenches gO\�1 .-•`�`-atment Type nia
> from foundation? - t\_- -\3 - 0 N/A Ei YES El NO
>50 ft. from wells? - - NOd \ 0 ❑✓ 0
Y >50 ft. from surface water? - ❑ ❑✓ 0
I Z - - -
Cleanout between building and tank? - - - 0 ❑✓ 0
U Tank baffles present? - 34 - ❑ ❑✓ 0
d24" access risers over each compartment?- - 0 00
W Effluent filter installed?- - 0 0 0
N Septic tank size 1250 HOUSE BROTHERS
gal Manufacturer
0 D-box water level and speed levelers used? - - 0 N/A ElYES El NO
DO Manifold/D-box accessible from surface? ❑
mZ Check valves installed? - - ❑ ❑ 4 - lu' ❑
oQ 2 INCH 40
P1
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) 0 2 123 ❑4 ❑ 5 ❑6
>10 ft. from foundation?- - ❑ N/A ✓❑ YES ❑ NO
>100 ft. from wells? - - ❑ ❑✓ 0
W >100 ft. from surface water? - - ❑ El El
r. >10 ft. from potable water lines?- - ❑ ❑✓ ❑
> 5 ft. from property lines and easements?- - 0 0 Eld > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 0
o o
Drainfield level and observation ports present - ❑ ❑✓ 0
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑✓ YES ❑ NO
• Pump tank size 1250 gal Manufacturer HOUSE BROTHERS
< 24" access riser(s)and accessible from surface? - - ❑ 0 0
a Alarm or Control Panel Installed? - - 0 ✓❑ 0
2 Control Panel equipped with Timer/ETM / Counter- - 0 0 0
D
CI- Pump installed in ❑ Bucket or 0 On Block or 0 Other
a'• Pump Make/Model ZOELLER N150 ❑✓ Floats or ❑ Transducer
a Tank draw down 1.75 in/min Pump capacity 42 gpm Squirt Height 2 ft
Pump on time 1.42MIN Pump off time 4HRS Daily flow set at 360 gpm
revised 1,22/2014
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
0 Drainfield&
manifold orientation
&layout
0 Trench/bed
dimensions and
critical distances
within layout
El Septic/pump tank
placement
SEE ATTACHED
❑� Location of
buildings
O Observation ports&
clean-out locations
O 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 f her certify that all infor • t'.n contained on this I further certify that all information contained on this
form nd ched Recor.Clwing is 1ccu .te. form and attached Record Drawing is accurate.
L 111/10/25
Sig ture of I elle`r Date
JAKE GOLDY
Printed Name of Signee 14.10/25
MASON COUNTY PUBLIC HEALTH '
The undersigned approves this Installation Report and "',
Record Drawing on behalf of Mason County Public "t ' .r
Health: • ADRIA J.HUNTER
.f- ''�III
41 k C
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
revised 1/22/2014
I
327'± •
\\
\ \ T \
7, ��` \
m\
\ 1\
cn \ \
D \ \
m \
m
is
\ tt \ \
�FR \
\
\ N \
\ U;
`\ N
1 C ^ \ G.)W
` oco
El µ
1 n 1
r
1� t co
Z ' v Aar'
1 -- ------:-.N.------'''.::\\N's\ :
117((,)/Q 4 1�
NZ
Om o
NA=N : II o \ m
n int'
= — D - - 1 v I x
Dy I
�
= � °' -.113] i m
o o x
N 1
Z
! O
w
N
m
O y N r
r
1
m 0 1
O = 1
r_
z
m
In
o
x
a
0
4,
f
'V _ '
W m r. ^.`: ..f:�.t
o = O 1 :z t` i '
o 7 n O —1 0 (/) 'bp �<
o � ti `�
oZ X * T
>o O m~ N O O Ri
vNJ 0 7 1l z 0K a m ? m c•->
C,
z
o - 71
o Z m OJ p n -
11_
O CO
Z ' C)u' •p Z 0 kipo
n z -0 =t:
rri VN
m 1 m
Q T
In z N z Q TI
LA
m D m z �_ --I-I
# p a > r JD y Z =
(n A _,m > 0 D
n x to m m %U r
o▪ (0 0 , 0 R1
N W
? O m m co P X)
o 73 Gl FS O
CO
o Q > i5 -<
v' D
u
A
0
1.