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HomeMy WebLinkAboutSWG2025-00181 - SWG As-Built - 9/16/2025 Docusign Envelope ID:07A31CB3-4EC7-4C64-BFDD-B840F61AD68C Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION 1Permit Number SWG SWG2025-00181 Parcel # 22028-50- K_;')t u 111 Applicant Name TRIMRI F .IFFFRFY R, TRFC.Y Subdivision (Name/Di 4 ocl�( )1 d 2025 f Applicant Address 41 SF ARKADA CTLt..; J City, State, Zip Shelton Wa 98584 Installer Name .;ii,...011 .• —__________— I -11 Site Address Same as mailing Designer Name Micah Halverson INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s) Only ❑ Drainfield Only ® Repair ❑ Other System Type Glendon Pin-filter Pretreatment Type M32 >5 ft. from foundation? - - ❑ N/A ® YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Z >50 ft. from surface water? - - ❑ El • Cleanout between building and tank? - - ❑ ® . ❑ U Tank baffles present? - - ❑ ® ❑ a24"access risers over each compartment? - - ❑ © ❑ W Effluent filter installed?- - ❑ ® ❑ U) Septic tank capacity (working) 1392 gal Manufacturer Sound Placement 9 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ® NO p0 Manifold/D-box accessible from surface?- - ❑ ® ❑ m Z Check valves installed? - - ❑ ® ❑ OQ E Transport Line Size Fxisting 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ® 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO O >100 ft. from wells? - - LI ® ❑ W >100 ft. from surface water? - - ❑ ® ❑ >10 ft. from potable water lines?- - ❑ ® ❑ Z > 5 ft. from property lines and easements?- - ❑ ® ❑ ce > 30 ft. from downgradient curtain/foundation drains? - - ❑ X❑ ❑ CI Drainfield level and observation ports present - - ❑ XD ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO Y Pump tank capacity (flood) 1244 gal Manufacturer sp < 24" access riser(s) and accessible from surface?- - ❑ © ❑ ~ a Alarm or Control Panel Installed? - - ❑ ® ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ X❑ ❑ D la. Pump installed in ❑ Bucket or ❑ On Block or X❑ Other nrencn easy pak300.5 i3 Pump Make/Model nrencn 3nas ® Floats or ❑ Transducer 2 a. a Tank draw down Glendon in/min Pump capacity Glendon gpm Squirt Height N/A ft Pump on time Glendon Pump off time Glendnn Daily flow set at 360 gpd 11 Updated 8/21/2018 Docusign Envelope ID:07A31CB3-4EC7-4C64-BFDD-B840F61AD68C Mason County OSS Installation Report pg. 2 Parcel# 22028-50-23001 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ® YES NO If yes, please describe:Saod mound abandoned Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ® YES Ej 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 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. Initial Owners initial: • ® 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 ,ogg4,Attoched Record Drawing is accurate. form and attached Record Drawing is accurate. 0911125 �—coaacr a i ay... Signature of Installer Date '11�1 OF Scott Johnson 4 ,Il Printed Name of Signee *t '�pl MASON COUNTY PUBLIC HEALTH 1 , � �'{�. � 1, The undersigned approves this Installation Report and ` 1 Record Drawing on behalf of Mason County Public '� A wRsON �11 Health f UCEMIOE.\(: 11-\.9-A/K • ° 1 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 8/21/2olt3 Tabloid 11"X 17" 0 . 0 �s:�osid tn c � d � TO BOAT RAMP • 3nNm� m , SE LYNCH RD poi 21p� 3a N o zav c-S�p r cD �tg-mc ¢ n �i 4, pSm °�g5 \\ U( CD aiSo8zNf9e \ n D 6 v Et e m co N j 0 0 3 a a \ r CA s 1 g5 \ u, A kcaR O m X. Q n -0m m O N. J R fl,l39 N \ ? N3 ry 3 ffn \ 0 Qn0 m \ _ �6 A n m R \ A 70 N N W \ S N p C] O1 7 kri ot O + . rzk--.._,9 co 1 AI N m oo E I rn CO -- D CD NI � � � wN <It) m CAE -' mmcn v c CX. X CD 0 y\ 713 ►-� N N,,> N to (n. *2 r c____ 1 / s. +ir iii 5. G) cn Z n -, / cp co co 0 �i:i�i o m N) . e s�� �. o w v O / �1. *: +� m c co 0 / \ v 4 Q- co D 7 dc/ ( ❖ / \ D `/I + cp � = ;/ ��• r- �•����� 5 5.1 . c a) \ 10' CD `, � m A D -4 Z CD oI a co iz ico 3 -4 Co T N \ \\ aE.I m E Cu Co 26' co to F .4(1') /\ / O p, • . \ / 0� 30 \ / \ E 1 h\ \ / �/ I \ / \a".E. 0 \ / 1J \ D / G) o\ / N 3 Cr 1 / 3 . c 1 / o o ,_,. (o , m� Tb C � I / / n V <r C m, I , m T _ w0 c 'v O _ rn - — - - - - - - I m --� a Cr) 0 'r I v N o I te. 3 0 o I iy z mCO / r- n / ti� * 0 CO / I // / CO 11 I H / o Ul / N O u n , ' n . � w c, o' 51c v • \ co x 1` ,` 2............., d� i . 1 ‘,N (o u' 1�'1 fin? 13 N I ��A. A3 1 S2i 3 H H H -_ jot M.Halverson Design LLC Owner/Applicant Site Info• sr(EErNUMSER JEFF & TRECY TRIMBLE Parcel# 22028-50-23001 PO Box 1519 Shelton Wa 98584 Mailing: 41 SE ARKADA CT Site Address Same as Mailing 1 HalversondesignlIc@outlook.com SHELTON WA 98584 REVISION#