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Home My WebLink AboutSWG2020-00338 - SWG As-Built - 6/30/2025 1- MASON COUNTY PUBLIC HEALTH Mason County OSS Installation Report CANT/ PERMIT INFORMATION Permit Number SWG 2020-00338 Parcel# 22005-11-90042 Subdivision (Name/Div/Block/Lot) Applicant Name Mark Ber ._ Applicant Address 175 E Phillips Lake Loop Rd Mason Coun Excavati • City, State, Zip Shelton,WA98584 Installer Name 9 Arrow Septic Desi•n- Site Address same Desi ner NameVIMMWINSit wan& INSTALLATION CHECKLIST ❑Tank(s)Only El Drainfield Only ❑ Repair E Other -O © Full System Installation S ha.�".e va -�, Q..s%�r-C� Pretreatment Type . System Type - ❑ NIA Q YES Or >5 ft. from foundation? - 0 ❑ >50 ft. from wells? _ 0 El 0 • >50 ft. from surface water? - ❑ 0 ❑ Z < Cleanout between building and tank? - 0 1 0 U Tank baffles present? - 0 0 a24" access risers over each compartment?- ❑❑ D 0 Lu UI Effluent filter installed?- Ha erman Septic tank size 1200 gal Manufacturer Q N/A ❑ YES ❑ NO 0 D-box water level and speed levelers used? - - CI 0 ❑ o mO Manifold/D-box accessible from surface?f �U vnp ❑ ❑ Z Check valves installed? OQ 2 Schedule/Class 40 E Transport Line Size Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other _ ❑ NIA w YES ❑ NO >10 ft. from foundation?-ci ❑ X ❑ >100 ft. from wells?- 0 W >100 ft. from surface water? CI El ❑ a-. >10 ft.from potable water lines?- ❑ • ❑ � > 5 ft. from property lines and easements?- - ElCL > 30 ft. from downgradient curtain/foundation drains? - - ® ❑ 0 a Drainfield level and observation ports present - ❑ 1.1 0 0 Graveless chambers or ❑ Clean gravel used? (check one) El ❑ Proper cover installed over drainfield?- ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A 0 YES NO Hagerman � Pump tank size 1000 gal Manufacturer ❑ < 24" access riser(s) and accessible from surface?- - ❑ © 0 F- Alarm or Control Panel Installed? - ❑ ❑ a El- g Control Panel equipped with Timer/ETM /Counter- ❑ CI- Pump installed in ❑ Bucket or E On Block or ❑ Other a. Pump Make/Model Liberty 280 0 Floats or ❑ Transducer 0=. Tank draw down 2 in/min Pump capacity gpm 38 Squirt Height 6 ft 6 hr Daily flow set at 354 gpd Pump on time 2.33 min Pump off time Updated8rztrzo18 Parcel# Mason County OSS Installation Re ABANDONMENT RECORD _ - - - - - -- - 0 YES 23 NO Were existing septic components abandoned as part of this proieC? __ CI YES 0 NO If yes, please describe: abandoned per WAC246 272A-0300? '-- " Were all components pumped out and properly RECORD DRAWING 7 ral Record Gture de.locationnf wells.watReco tank location.North arrow.reserve drairfield,existing and proposed nal installation approval and related pertness. ertnanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development This a Pcreate additional delays points. Incomplete Record Drawings may Drawings contain: Drairt`eld&manifold orientation&layout.Septi Pu Us,observation pots.d¢anouts,and other maintenance access Po Sep ( W _ Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNER!ENGINEER INSTALLER led in accor- I certify that I installed the system in accordance with I certify that the system has been dance with the septic design stamped AAPPROVED"by the septic design stamped"APPROVED"by Mason County Public Health and that any deviations shown Mason County Public Health and that any een by deviations here have been cleared/approved by both the designer shownself and Mason County Public Health and meet all and Mason County Public Health and meet all State mState and Mason County Codes and Mason County Codes. !further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and atta ed Record Drawing is accurate. _ 3Dae21 ,,tyy11 Si nature of Installer V 1l _,�. Printed Name of Signee •o1 „�;•ZJ r� MASON COUNTY PUBLIC HEALTH t^,J-r• The undersigned approves this Installation Report and ;� ' Sto :Its ;o?''i Record Drawing on behalf of Mason County Public �� ,7 PAULA JOY.IOHNSON L�), Health: '� Kcal�:,'b4Tf _ ry\ b (-50 f-? Signature of Environme tal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated arz12018 6 F 4N414''\ CtPle 1 kP54Lk 11 L j ll 0 Vti COVAAN4 Ac.�kS S L., 35g51of'e Sev: ( )3x 9 O'riff? - - 1 Audio-visual. 0? -rren 0'1' . rig.trce — -- - . h ~— 1 3 Cleanout r (V 4 katiovi11 . 01200 Gallon Septic Tank "� ir 2-Compartment with 0 l Effluent Filter ® I O 1000 Gallon Pump Chamber ra: VP O Valve Control Box • .. Cl_ \ --30' ?rofoSQd 3 BR at ll o N 1l ia' WO APPROVED JUN272025 I MASON COUNTY ENVIRONMENTAL HEAL H l RET l • 2-Forty well , existcr j °rival t{cra1'c.e __... ..___A_S_\12.i.Lt____--- Mar 4. er r , ICZZK ----- ParC{[ 1#ZZ00.5-1 - gooKZ 1�5 111.01hc t2L ',q't . Shelton . . .) ��h o 15 3o 4% (00 p •. 'i• VP JOY JOHL.,,c\*.c)CYO\S M Da I NSON . C� ..