HomeMy WebLinkAboutSWG2025-00222 - SWG As-Built - 8/8/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00222 Parcel# 42024-15-01150
Applicant Name Shirley Anderson Subdivision (Name/Div/Block/Lot)
Applicant Address 1561 W. Railroad Ave
City, State, Zip Shelton,Wa Installer Name Spear Const.
Site Address Same Designer Name Bob Paysse
INSTALLATIO - ' CKLIST
• Full System Installation ❑Tank(s)Only ■ %rainfield Only 0 Repair ❑Other
System Type Sand aug.-Pre re ✓G z. •treatment Type
>5 ft.from foundation? e p__ _' - ❑ N/A YES El NO
>50 ft.from wells? - �S'G -1--1?,--- - 0 ® 0
>50 ft.from surface water? - mod- - - -- I ® ❑
Z
H Cleanout between building and tank? - __ 0 II El
U Tank baffles present? - -- ❑ I ❑
H 24"access risers over each compartment?- - ❑ U ❑
a MI ElW Effluent filter installed?- - ❑
N Sound Placement
Septic tank capacity(working) 1500 gal Manufacturer
G D-box water level and speed levelers used? - - I N/A ❑ YES ❑ NO
J NI El
Manifold/D-box accessible from surface?- - 0
mZ Check valves installed? - - ❑ II ❑
DQ 2" Schedule/Class 40
2 Transport Line Size
Bedrooms installed (check one) 0 2 [3 3 ❑4 0 5 0 6 0 Commercial/Other
>10 ft.from foundation?- •- ❑ N/A ® YES 0 NO
p >100 ft.from wells?- - 0
NI El
W El IN El
ft.from surface water? - -
ti, >10 ft.from potable water lines?- - ❑ III 1=1
Z > 5 ft.from property lines and easements?- - 0 ® ❑
a >30 ft.from downgradient curtain/foundation drains? - - 0 III ❑
el
Drainfield level and observation ports present - - 0 I 0
0 Graveless chambers or Fp Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 ® 0
Pump tank setbacks consistent with septic tank? - - ❑ N/A iffil YES 0 NO
Pump tank capacity(flood) 1500 gal Manufacturer Sound Placement
<
24"access riser(s)and accessible from surface?- - 0 U 011
F- Alarm or Control Panel Installed? - - ❑
a ❑
Control Panel equipped with Timer/ETM/Counter- - ❑
Pump installed in 0 Bucket or ® On Block or 0 Other
2 Pump Make/Model Liberty 290 ® Floats or ❑ Transducer
Q.
a Tank draw down 3" in/min Pump capacity 90 gpm Squirt Height 53" ft
Pump on time 1 min. Pump off time 6 hrs. Daily flow set at 360 qpd
updated 8/21/2018
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Mason County OSS Installation Report pg.2 Parcel# 42024-15-01150
ABANDONMENT RECORD
Were existing septic compo ents fb do.n.1ed� as part of this pro'ect? - - ill YES NO
If yes, please describe: ; QI, J.L k. p cj`a.
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ® YES El 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: Draintield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve dralnfeld,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.
® 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
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
n. 7/i7/ ,5
Sr na of Ins)1)24t,"\___
Date
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Logan Spear ,f,
Printed Name of Signee tie ,
Al:t � `
MASON COUNTY PUBLIC HEALTH !tii . • ��-'--
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The undersigned approves this Installation Report and 1►r`- F ;,: t`•'•.: . i
1 ; ,7 ,.:y
Record Drawing on behalf of Mason County Public $,a', aoa . RAMIE
Health: `-
EXPIRES
\ 7,,,,,.,„,e,-„, 66I9j
Signature of Environmental Health Specialist Date (stamp, signature and date)
Updatedantrzota
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
1 .....---' // I CITY WATERLINE
1.0-4"... r I FED FROM ROAD
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EXISTING DRIVEWAY
EXISTING HOME
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I 1 EXISTING TANK/OSS:
I 0 --T-- PUMPED & ABANDONED
1 , 0 I
PER CODE
1 -- SHED
SEPTIC TANK °- °
& PUMP TANK o 0
_ °
3. I INSTALLED 3 BEDROOM
o / 7 * 'I —T-- PRIMARY & RESERVE
I AS PER DESIGN
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EXPIn S
I RECORD DRAWING
CUSTOMER: SHIRLEY ANDERSON VEST HOLE I: TEST HOLE 2:
PIONEER DIGGING, INC. PARCFI# 4202415-01150 "{'
416 `2-j`G
1< S. I.12(4.S
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SEPTIC DESIGNS ADDRESS: 1561 W RAILROAD AVE ROO IS 01 Rags-60
DESIGNER: ROBERT FL PAYSSE P��N� VES. NOT A SURVEY. NTSANDC COUNT'INCLUDE DESIGN INTEOVNTY PROVIDED
3083 E MASON BEN.S)N RD. GRAPEV IEW,WA 98546 PIATS CR RVRTHIS IS NOT A SURVEY. EFEREN SRCN B APPLICANT/COUNTY
ANT/COUNTY R VIED
OFFICE-360 426-I803 FAX-36(1-427-2353 SHEET: ASBUILT SCALE:
30' PURPOSES ONLY PROPOSED OEVELOPI NP WY BE SUBJECT TO OTHER
IA= CEPPRT% NT/AGENCY REVIEW DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC COMPONENTS