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Home My WebLink AboutSWG2025-00093 - SWG As-Built - 4/17/2025)cusign Envelope ID:776BA98F-9FEA-471A-9587-66D664229859 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00093 Parcel # 42025-75-00300 Applicant Name CAPPIELLO. GEORGE J &ANN MARubdivision (Name/Div/Block/Lot) Applicant Address 890 W WYNWOOD DR City, State, Zip Shelton,Wa 98584 Installer Name Jamie Workman Site Address 890 W WYNWOOD DR Designer Name Micah Halverson INSTALLATION CHECKLIST — 0 Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pressure Trench ``n ment Type Septic Tank >5 ft. from foundation? , 8�q-L+��} ❑ N/A 0 YES El NO >50 ft. from wells? - >50 ft. from surface water? T ��R�-A-V1 - ❑ 0 ❑ Cleanout between building and tank? - - - -.-7,- - -- Tank baffles present? - - ❑ 0 ❑ F- 24" access risers over each compartment?- - - ❑ a. - ❑ ❑ W Effluent filter installed?- N Septic tank size 1778 gal Manufacturer Infiltrator 2 Compartment IM1250 0 D-box water level and speed levelers used? - - x❑ N/A El YES ❑ NO J ❑ �O Manifold/D-box accessible from surface?- - ❑ ❑❑ CI ❑ co 2. Check valves installed? thQ Schedule/Class 40 2 Transport Line Size 2" Bedrooms installed (check one) El 2 © 3 ❑4 El 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A x❑ YES ❑ NO o >100 ft. from wells? El CI J >100 ft. from surface water? - - ❑ ❑ W 0 ❑ LT_ >10 ft. from potable water lines?- ❑ z > 5 ft. from property lines and easements?- - ❑ 0 ❑ cc > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑ o El ❑ Drainfield level and observation ports present ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) ❑ Proper cover installed over drainfield?- - ❑ x Pump tank setbacks consistant with septic tank? - - El N/A El YES ID NO Y Pump tank size_1480 dal Manufacturer Infiltrator 1 compartment IM1250 < 24" access riseres) and'�ceissi .*f n surface?- - Cl 0 ❑ H Alarm or C olf attel Instalfied? - 1 - ❑ a 2 Control Pa 1 •uiproteith jfii �' ETM/Counter- ❑ ® ❑ P` a- Pump inst. ��t00��,'❑ On Block or ® Other Qrenco EZ-Pak a0�' 0 Floats or El Transducer 2 Pump Make/Model OrenoiS 005 a Tank draw down 2 in/min Pump capacity 60 gpm Squirt Height 6' ft Pump on time 45 sec Pump off time 4hrs Daily flow set at 270 gpd Updated 8/2112018 ocusign Envelope ID:776BA98F-9FEA-471A-9587-66D664229859 Mason County OSS Installation Report pg. 2 Parcel# 42025-75-00300 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ® YES E NO If yes, please describe:Failed Septic Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ® YES ❑ NO RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines. wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits See Approved Design Ili1) Fi " -,:o *I'lii; r] '77\.' APR 1 7 2025 MASON COUNTY ENVIRONMENTAL HEALTH JBW E 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 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 faJ,Attpched Record Drawing is accurate. form and attached Record Drawing is accurate. CC4,,,,JJh4Nt541.t (14-10-2to25 Signature of Installer Date di ami e workman \2°� lit i Printed Name of Signee U\\/ \f, MASON COUNTY PUBLIC HEALTH �``idt Ili The undersigned approves this Installation Report and + - I Record Drawing on behalf of Mason County Public ,:-7 51} WLy 100400 �I Heal i. • �. tiL/Q, (4 -17 ' 24 1.1 LICENSED DESIGNER EXPIRES:OW16! Signa ure'.* vironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 0 0 0 3 BEDROOM ON-SITE WASTEWATER ASBUILT SWG2025-00093 0. m m 0 -a m 0 V co 03 > co J co Otio �- > -4 rn /'v� ) (D �(/i-/ •'' c� cco n �� ? co E IJ NJ coco I I \t✓✓,'11\10 v\ '�. w1 = • H T:;A'aEL HALVERSON UCER;'ED DESIGNER e' j-''•0+97fa1 N • A .A o 2bili z , 0' 40' SO' 120' CD —ter Scale: 1"=80' to 02 z _c r D CD '\` Approximate Land Size: 11 13 AC n., O I L' C r nil I ;r1:‘"\:?., -'.• I 1 I/ P,oc, t.C .t :' + (V I Wei! (1 I I w 1 - a, SPA Easement >1 , — \ I 'Setback from BPA Easement' / \ N Droi / \ \ e/d,4rea 5/ope 7Q5 / \ \ IO N \ 0 sift Reserve Trenche "ri 3mary Trenche- / Rr/00, T ` 5'42'63'l0' C�3'Xl2' 1 1 Well Comer of Deck 1 °g_ I 5 3 ,p,- '.�'' h1R��OpO • c r Al 1 of km I - 1 � ------ o‘'064>64 1)4"ASTM 3034 Sewage Line with Cleanout ' \ 2)MVP Control Panel&Power disconnect I 4 10' \ / 3)2"5ch40 Effluent line \ 4)Infiltrator IM1250 Septic Tank&Pump Chamber I Existing SFR ' 5)Manifold Access I n Including Decks&Garage 6)Sweep Access&Inspection ports This end of Each Trench -- I 1 Agoxt This is not a surveu: 1 This Asbuilt Praying is intended for the purpose of locating and maintaining the septic system on this parcel. Measurements and distances are approximate. I It is advised by septic designer Micah Halverson f. 11 to use a licensed surveyor to determine lot lines, lq elevations,topography and to provide a legal site plan. PROPERTY LINES AND EASEMENTS ESTABLISHED BY OTHER _ Owner is responsible for establishing all property lines, easements and/or right-of-ways. 256'+/- inspection Date:4/10/2025 M.Halverson Design LLC Owner Applicant' Site Info. Parcel# 42025-75-00300 SHEET NUMBER PO Box 1519 Shelton Wa 98584 Cappiello, George & Ann Marie 890 W WYNWOOD DR 1 890 W Wynwood Dr Halversondesignllc@outlook.com Shelton,Wa 98584 F:ISI:‘.