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HomeMy WebLinkAboutSWG2024-00371 - SWG As-Built - 9/11/2025 .mow Docusign Envelope ID: C049D61B-43E1-46C6-A288-B04135B34031 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00371 Parcel # 42024-34-90049 Applicant Name p,SCW INVFSTMFNTS II C Subdivision (Name/Div/Block/Lot) Applicant Address 70(10 W SHFI TON VAI I FY Rfl PCl 4 OF RI AO 23-42 City, State, Zip Shelton Wa 98584 Installer Name I ogan Spear Site Address 320 W BFRRY RIDGF RQ Designer Name Micah Halverson INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type gravity Red Pretreatment Type Septic Tank >5 ft. from foundation? - - El N/A ®YES ❑ NO >50 ft. from wells? '�� ';? ��J-� ❑ ® ❑ >50 ft. from surface water? - 5; �';��r;.,:�� - - ❑ ® ❑ H Cleanout between building and tank? -' ) - ❑ ❑ 25 NB- - El Tank baffles present? - - LI - A�� ❑ ❑ U IE • ! CI 24" access risers over each compartme 7- - - - - ❑ W Effluent filter installed?- -B --- ' - - - El ® El N Septic tank capacity (working) 1200 gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? - - ❑ N/A ® YES El NO �J CI El ❑ O Manifold/D-box accessible from surface?- - on Z Check valves installed? ❑ ❑ IEJ the Schedule/Class ASTM 3034 E Transport Line Size 4" Bedrooms installed (check one) ❑ 2 ❑ 3 ®4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A ® YES ❑ NO >100 ft. from wells? El ® ❑ W >100 ft. from surface water? ❑ IE El ® Elti >10 ft. from potable water lines?- ❑ z > 5 ft. from property lines and easements?- - ❑ ® ❑ Q ce > 30 ft. from downgradient curtain/foundation drains? ❑ ❑ ID o - LI Drainfield level and observation ports present ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) ❑ Proper cover installed over drainfield?- - CI El Pump tank setbacks consistent with septic tank? - - ® N/A El YES ❑ NO Pump tank capacity (flood) gal Manufacturer Z ❑ < 24" access riser(s) and accessible from surface? ❑ ❑ ❑ 1— a. or Control Panel Installed? - - ❑ a * Control Panel equipped with Timer/ ETM / Counter- Ill III ❑ D CI- Pump installed in ❑ Bucket or El On Block or El Other Cl.2 Pump Make/Model ❑ Floats or ❑ Transducer Q. Tank draw down in/min Pump capacity gpm Squirt Height ft Q. Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Docusign Envelope ID: C049D61B-43E1-46C6-A288-B04135B34031 Mason County OSS Installation Report pg. 2 Parcel# 42024-34-90049 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Ei 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,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. Note: Install septic tank inlet-baffle and cleanout when plumbed to sewage source. See Approved Design ® 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 1 further certify that all information contained on this I further certify that all information contained on this jga„attached Record Drawing is accurate. form and attached Record Drawing is accurate. ,b �SI aY 8119/75 oaur Signature of Installer Date `Z�i \2 4 t4l (Doan spear % Printed Name of Signee MASON COUNTY PUBLIC HEALTH '` f The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public St1Y 0040 la �vE�eoH Health: UCEMED WAGNER +� r � � �y�J1 Q I I I �� WIRES:oa+1eisa_ 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 8/21/2018 Tabloid 11"X17" o 0 0 w coo" x s /� cn' N 23 3 0 ^� i '' 5(n i l / - m 7 N 3 a' (n C v 0- • C CD • 0003 2-Gg C7 m / T. t. CD oN`a co N m - T. �' N'3 a / IC)Z > ill k n „ . N 3 z (s'Q 3_.�_ / N A Q N E.N 73 3. . 4,O 3 t N 3 lfl / Q y n 3 Z Gl� t N to V1 iga, .° � / r. 161'+/_ • N .3D3 as / z /v `0 m ▪ 2 �o is d F.o m 5 CE mmcDwocoa / No • — . . o 0 ��o< m g I m • 3 N m3 3 3 0 / —4 r —1 • co K cn 3 �m / Dr Vel co (D▪c T R "cl /V N co / r -n d 00 00 / 0 � ' 73 (3 44. 47 0 / Reserve Bed �n -r� © 24054R / � y ' � 'ti / ' (W) / x"'/ 'k 1 166' +/- N / / 0 7r,/ rn / 0 / / / < (2a, c� / /� / "0 k) 0 / // w to IP- / / ti I, / / .--- /- / , / � X / / • / ccoo • I �\ / 7h .: A / / I ?\ • 1..)0• .. 8 /X _.s... / \ / CU \ o /// ( A _ 7"---- / 11 N — + (-, 4 (.1Z 110- I •• ) Ifc / • / -\ / Z7 // / W N) .� . -0 0 ,, I) / 00Crrn / \.-- co G) — —{ Pp N. l1.- / <co (D N) — O 7 O . am � Q '4' �e i / I CD B co U) xi I I 0 ' o Fij 2 I I 3 cD Q r- v 1 1 o CD w- 0 < — -c * G) . \ \ n o N) I I psi O 0 O \ \ — 0 ` I I t I •\'c-----1 z• • tc t` � iti. �un oI = yVAT" i (b rn e gil I. 3 I § CD i I i I I U ` I a I S ti I / Resulting Parcel 4 Of BLA2023-00042 AF#2212781 M.Halverson Design LLC owner/Applicant ASCW INVESTMENTS LLC ,SitP Into Parcel# 42024-34-90049 SHEET NUMBER PO Box 1519 Shelton Wa 98584 2000 W SHELTON VALLEY RD 320 W BERRY RIDGE RD 1 Halversondesignllc@outlook.com Shelton, Wa 98584 REVISIONtt: