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Home My WebLink AboutSWG2024-00094 - SWG As-Built - 1/15/2025 Dowslgn Envelope ID:074089T-B1A74W9-B4e8-458EC43C8922 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00094 Parcel# 12031-12-00020 Applicant Name cijisijoi M wll I IAM Subdivision (Name/Div/Block/Lot) Applicant Address 91 rTamarack Ln City, State, Zip Shelton,We 98584 Installer Name Micah Halverson Site Address 851 E CAMDEN WAY Designer Name Logan Spear INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s) Only ❑ Drainfeld Only ❑ Repair ❑Other System Type T Pretreatment Type >5 ft, from foundation? - - - - - - -- - - - - - - - - - - - - - - -- - - - ❑ NIA DYES ❑ NO >50 ft.from wells? - - - -- -- - -- - - - R- - ❑ ® ❑ Z >50 ft. from surface water? - - - - - - - - U �a� - ❑ ❑ Cleanout between building and tank? - - - El ❑ El V Tank baffles present? -- - - - - - - - - - JAN1+2W ❑ ❑ t- 24"access risers over each compartment-- -- -- - - - - -- - - - ❑ ® ❑ W Effluent filter installed?- - - - - - -- - - -! "- --- - - - - - - - - - - - ❑ 0 ❑ Yn `_ Septic tank capacity (working) 1 SDD gal gnu ountl Placement 11 D-box water level and speed levelers used? - - - - -- - - - - - - - -- ❑ NIA x❑YES ❑ NO DJ U. O Manifold/D-box accessible from surface?- - - - - - - - - - - -—- - ' ❑ gOZ Check valves installed? - - - - - - - - - - - — - -- - - - - - - - - - - ❑ ❑ �Q f Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑3 ❑x 4 ❑ 5 ❑6 ❑commercial/Other >10ft. from foundation?- - - - - - - - - - - - - - -- - - - - -- - - - - ❑ NIA © YES NO >100 ft. from wells?- -- -- - - - - - - - - -- - - - - - -- -- - -- -- ❑ x❑ ❑ W >too ft.from surface water? - - - - - - - - - - - - - - - -- -- - - -- ' ❑ ® ❑ LL >10ft. from potable water lines?- - - - - -- - - - - - -- -- -- - - -- ❑ ® ❑ Z > 5ft. from property lines and easements?-- - - - -- - - - - -- - - - ❑ © ❑ K > 30 ft.from downgradient curtain/foundation drains? - - - - - - - - -- ❑ ® ❑ Drainfield level and observation ports present - - - --- - - - - - - -- ❑ ® ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - - - --- - - - - -- - - - -- - ❑ ❑ Pump tank setbacks consistent with septic tank?-- -- - - - - ---— x❑ NIA ❑ YES ❑ NO Z Pump tank capacity (flood) gal Manufacturer QF 24" access risers)and accessible from surface?- - - -- - -- - -- - - ❑ ❑ ❑El ❑ IL Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - -- "- ❑ Control Panel equipped with Timer I ET M I Counter- - - - - - - - - - - El ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 1L Pump Make/Model ❑ Floats or ❑ Transducer � Tank draw down in/min Pump capacity gpm Squirt Height ft a Pump on time Pump off time Daily flow set at gpd Docusgn Envelope ID.07408977-B1A74B69-B488458EC43CBW2 Mason County OSS Installation Report pg. 2 Parcel# 12031-12-00020 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -- - - - - -- ❑ YES x❑ NO If yes, please describe. Were all components pumped out and property abandoned per WAC246-272A-0300? - -- - - - - - ❑ YES ❑ NO RECORD DRAWING This is a peomment record and must he mount and Macrlpnve arougk to re-IouLL In Ma neM M malnbnams acavmes and rutun deyebpmMt Typitel Retool Drawings wmaio Dn'n a ma ftM wen�8 Mya ,S pt/Wmptank bulW NWh a ,,reanve dmff d,eximing and proposed W IMINS,buYon dr lc,xemdines, miis,obe nmp ,d ms,aMohermeimwwmass%ime. InC pM Recall DmmngsmycremeadR aldekytomal'nemiwwapN landme Wlmds. Comment: Install Inlet Baffle and Pipe when connected to Sewage Source. x❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 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 clearecimpproved by both the designer shown hem 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 f ¢,attached Record Drawing is accurate, form and attached Record Drawing is accurate. SFL W rgrps 5 Ins r Signature of Installer Date I onan Spear Printed Name of Signee �YIr4l, MASON COUNTY PUBLIC HEALTH F The undersigned approves this Installation Report and yyBrry Record Drawing on behalf of Mason County Public Health: par�:atrfe.2$- Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updm ad WIM1e g m8^ao� n To: E Harstine Island Rd 5 m 3 el amocJ � mom, � msgmQ 410' +/- m ou �rt6S� S ary N tj N m R� Nm� ^ J m w O g. R m V V C Tt m 9 71lp Sn mno o, S (1) r/) m mry Tag. CD `G a am °aX a CD mju O3 m r P N 3 2 m N O y01 ry CnCID — N n N -0 g O � ON O p Ja A Ti -IA. PO� A � RD ar� 00. 0 ti M OOJZOM �y A4 N O t C O y QmO " pO m J � 3 N � z m D 0 - 0 om3 nos X sJ a o» m 1 001 » / \ c / a 4�1 Na • �& no i ai � n _O O S N \ a m E` ZZI � y 1 P O e c asp I "—nn1nan illia` r eJnto Parcel# 12031-12-00020 If 0MB0. M.I-lalverson Design LLC William G Chrisholm, .1r PO Box 1519 Shelton Wa 98584 91 E Tamarack Ln 851 E CAMDEN WAY, SHELTON 98584 Halversondesi nllc a outlook.com00. Shelton Wa 98584 aE o".