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HomeMy WebLinkAboutSWG2025-00023 - SWG As-Built - 9/16/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00023 Parcel # 32029-43-00100 Applicant Name Amy Hardie Subdivision (Name/Div/Block/Lot) Applicant Address 698 SE Mill Creek Rd TR 10 OF SW SE PCL 4 OF BLA#00-37 City, State, Zip Shelton, WA, 98584 Installer Name Maples Excavating Site Address 700 SE Mill Creek Rd, Shelton Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST Drainfield Only ❑ Repair Other Attenuaton Zone © Full System Installation ❑Tank(s)Only DI System Type Gravity Trench Pretreatment Type >5 ft. from foundation? - jt�' 'a` ❑ N/A Q YES ❑ NO >50 ft, from wells? l o j `-' ❑ Li ❑ I � _ Z >50 ft. from surface water? - -ifl ❑ 0 ❑ H }Cleanout between building and tank? - - ❑ 0 ❑ U SEP 0� 2025 t Tank baffles present? - 7 ❑ 0 ❑ Pi' 24" access risers over each compartmen ':+;F - - - - I:] 0 ❑ W Effluent filter installed?- - ❑ 0 ❑ U, Septic tank capacity (working) 1250 gal Manufacturer Hagerman o D-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO �J O Manifold/D-box accessible from surface?- - ❑ 0 mZ Check valves installed? - ' ❑ ❑ 0 o Q E Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ■❑ YES ❑ NO >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - ❑ 0 ❑ tr. >10 ft.from potable water lines?- - ❑ ❑■ ❑ Z Q 5> ft. from property lines and easements?- - ❑ 0. ❑ re > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑ o - Drainfield level and observation ports present ❑ IN D ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ -•-•. tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES a NO • Pump tank cap- flood) gal Manufacturer Z < 24" access riser(s) and ac - •le from surface? ■ ❑ ❑ ~ Alarm or Control Panel Installed? - - - - El El a 2 Control Panel equipped with Timer/ ETM/Coun - - - ❑ ❑ ❑ n a Pump installed in ❑ Bucket or • '• a ock or ❑ Ot - a• Pump Make/Model ❑ Floa .r ❑ Transducer d Tank dra --**n in/min Pump capacity gpm Squirt Height ft 'ump on time Pump off time Daily flow set at .-• Updated 8/21120,8 Mason County OSS Installation Report pg. 2 Parcel# 32O Z� ' -f -Cot OO ABANDONMENT RECORD Were existing septic components abandoned as par: of this project? - - [ YES ® NO If yes, please describe: 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: Grainfield&manifold onentation&layout.Septicipump tank location,North arrow,reserve drainfield.existing and proposed builcings,location of wells,waterlines, wets,observation ports,cleanouts,and other mantenance 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. " • AZ 1, R- 3- 2S Signature of Installer Date .04N, Printed Name of Signee f o, itt f� MASON COUNTY PUBLIC HEALTH 4r=;, iy The undersigned approves this Installation Report and r ,�; 1 t-� SIC.3411 Record Drawing on behalf of Mason County Public 1-re. PAULA JOY JOriNSON 'v� Health: .11:MIS 'bl`Mft;>vgft" ONNVin,f(011 Ct II Exptfzes Pt Signature of Environmental Health Specialist Date (stamp, signature and date) g THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE update-a 821/2018 Ji r 7 'fi---- ' ki 1 tiN f it t1e,0 f itz4 tf G \ 1 It i \ L ___-4e--' --' . . . , , 38 x-31 . ! , ci-k- 1 , , __ _ ,„,.,\,..vs e Pp�-pore Nt6TAtp(, — �- i C. 5' V ELL m3e9. -35c' (,\ �' 2 _ , (i� '� - t�%9-4Pr f 1 cc I1 i I in L1111 �p 1 t . t j`9Rspogc _" _D ;' %— tT C 3Ss __ 2.BR -.\t-k---c-14 Key: /� 0Cleanout APPROVED 22 1,200 Gallon Septic Tank SEP 16 2025 2-Compartment with Effluent Filter MASON COUNTY ENVIRONMENTAL HEALTH 0 D-Box with speed-levelers RET I and cover to surface = 335 Scpu_s: 1 _ 3 c r D 15 30 i5 ma �5. 44)) s- ); 1f , ; ?�. PRC-E 3 9 43 001cc) ' ), �,, sto�3a9 ';t;;rv'� —1 t,D SE M 1 LL C5REE�, R D '-.p? PAULA JOY JOHNSON '4t Sft i To f , Cr' '-ir .(� W � , R—R_2'C-