HomeMy WebLinkAboutSWG2025-00032 - SWG As-Built - 7/10/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00032 Parcel # 22128-77-90042
Applicant Name STEPHEN FEWELL Subdivision (Name/Div/Block/Lot)
Applicant Address 4703 PACIFIC HWY E
City, State, Zip FIFE, WA 98424 Installer Name NORTHWEST CASCADE INC
Site Address 570 STRONG RD, SHELTON Designer Name ALEX PAYSSE
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair ❑Other
System Type CONVENTIONAL GRAVITY Pretreatment Type
>5 ft.from foundation? - - - - ❑ N/A ®YES ❑ NO
>50 ft.from wells? - -� �� - - - - - Ell-1
I 0
>50 ft.from surface water? - - - - �4, - -- ❑ ® ❑
Z 5 0 ID
between building and to • - J�t-o-�•�, �-- ---
0 Tank baffles present? - - 0 I 0
I— 24"access risers over each compa ment?- - - - - - - 0 II
W Effluent filter installed?- BY - - — - ❑ ® ❑
U)
Septic tank capacity (working) 1537 gal Manufacturer INFILTRATOR IM-1530
❑ D-box water level and speed levelers used? - - ❑ NIA ®YES ❑ NO
DO Manifold/D-box accessible from surface?- - 0 5 0
mZ Check valves installed? - - 0 ❑ ❑
❑Q
2 Transport Line Size 4" Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - 0 N/A ® YES ❑ NO
0 >100 ft. from wells?- - 0 ® 0
W >100 ft.from surface water? - - 0 ® ❑
LL >10 ft.from potable water lines?- - ❑ ® 0
> 5 ft. from property lines and easements?- - ❑ ® ❑
> 30 ft.from downgradient curtain/foundation drains? ❑ ® ❑
Drainfield level and observation ports present - - 0 II ❑
❑ Graveless chambers or Q Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 5 ❑
Pump tank setbacks consistent with septic tank? - - ® N/A 0 YES ❑ NO
• Pump tank capacity(flood) gal Manufacturer
< 24"access riser(s)and accessible from surface? - - ❑ ❑ ❑
~
a Alarm or Control Panel Installed? - - ❑ 0 0
2 Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑
D
O. Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
n'• Pump Make/Model ❑ Floats or ❑ Transducer
p.
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 8/21/201 a
Mason County OSS Installation Report pg. 2 Parcel# 22128-77-90042
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES D NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 0 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.Ncrth arrow,reserve drainfield.existing and proposed buildings,location of wells,waterlines,
wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
• Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 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
form an attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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gnature of Installer Date C(t�t o•lf++
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Printed Name of Signee Ilite 14
MASON COUNTY PUBLIC HEALTH �q f:..
,
The undersigned approves this Installation Report and „Pik / "::.•. Vi
iti ALEX LOUIS PAYSSE ��
Record Drawing on behalf of Mason County Public a a y N,i••• t
Health:
( 1,d(Zc
Signature of Environm ntal 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
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CORDID ING- AN ASBUILT/INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
PIONEER DIGGING, NC. PARCEL :2 8-7-EN FEWF11 TEST HOLE I: I EST HOLE 2: TEST HOU-
PARCEL 22128 TI90042 060 L4lS 0-63 L_ALS 0-541.�1
6U+CO.�U'.A>5 TH@63 54+Low.\t-
SEPTIC DESIGNS ADDRESS.: 570 E STRONG RD ROOTS @ 60 ROOTS @ 63 KOOI S @ 54
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3083 E MASON BENSON RD. GRAI'EVIEN',WA 98546 DESIGNER: ALELPAYSSE DISCLAIMER:
A OEs TIRE�EOT A �r INCLUDE
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PuRRROESFILLDMEASMENTSANOCOUN1Y.REFERENCES GI D SEINTENDEDFORSEC
OFFICE 3604261803 FAX 360-427 2353 SHEET: ASBUILT SCALE 1"=10'
DEPPURPO TO ODIER
AR MENTIAGENCY REVIEW DESIG ER NOT RESES ONLY PROPOSED DEVELOPMERT ONS BLE FOR RETRACMAY BE E STUNRELATEDTO
SEPTIC COMPONENTS