HomeMy WebLinkAboutSWG2025-00364/ASBUILT - SWG As-Built - 10/21/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00364 Parcel # 32021-53-02011
Applicant Name TOSHIKAZU OCONNELL Subdivision (Name/Div/Block/Lot)
Applicant Address 450 E PARKWAY BLVD
City, State, Zip SHELTON WA. 98584 Installer Name SCHOENING EXCAVATION
Site Address 450 E PARKWAY BLVD Designer Name CINDY WAITE
INSTALLATION CHECKLIST
iii Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type PRESSURE DIST Pretreatment Type
>5 ft. from foundation? N� -� N/A YES NO
,.>50 ft. from wells? L2' - --\. ‘ ❑ ❑
>50 ft. from surface water? » �k �_ .) EI ❑
H Cleanout between building and tank? - -- 4 - DC,1 1 5 - lg. ❑
o Tank baffles present? - - - - - - - IZI ❑
F. 24" access risers over each compartment?- 8g- - - - - - - - ❑ ❑
W Effluent filter installed?- - ❑ E ❑
Cl)
Septic tank capacity (working) 104V gal Manufacturer 2t' (- ✓„ u'
9 D-box water level and speed levelers used? - - rZt N/A ❑ YES ❑ NO
DO Manifold/D-box accessible from surface?- - ❑ JR IN
oQ Check valves installed? - - El .
.•41 4 \ ri
2 Transport Line Size ,D i' Schedule/Class lit) c 4010
Bedrooms installed (check one) 121:2 ❑ 3 ❑4 ❑ 5 ❑6 El Commercial/OtherI
>10 ft. from foundation? "42 eyu.+dills Ad - - - - gr NIA ❑ YES ❑ NO
CI >100 ft. from wells? - - - - - - ❑ ® ❑
W >100 ft. from surface water? - El ® ❑
u. >10 ft. from potable water lin s?- - ❑ 14 ❑
QQZ' > 5 ft. from property lines an easements?- ❑- ❑ ElQ' > 30 ft. from downgradient c rtain/foundation drains? - ❑ ❑
Drainfield level and observatipn ports present - ❑ gl ❑
XrGraveless chambers or ❑ Clean gravel used? (ch ne)
Proper cover installed over drainfield? 'LEA' g ❑
ffi
Pump tank setbacks consisteit with septic tank? - -- • /A [3 YES ❑ NO
`O 5140418
Z Pump tank capacity (flood) 1..f 7 gal fad �AITE I 41as.rs l [!L a
Q 24" access riser(s) and accessible from surface? N.�Zra.— ® ❑
I—CL Alarm or Control Panel Installed? - t x"`r:5 �s.,o,
• Control Panel equipped with Timer/ ETM/Counter- - ❑ g ❑
n- Pump installed in ❑ Bucket or X( On Block or ❑ Other l\i
iZ Pump Make/Model L., b '510 ❑ Floats or g Transducer
d Tank draw down I 'fY in/min Pump capacity .33 gpm Squirt Height S,S ft
Pump on time I ry rs.r 20 ere Pump off time L h1K,/ Daily flow set at (7S gpd
I Updated 8/21/2016
Mason County OSS Installation Report pg. 2 Parcel# 32021-53-02011
ABANDONMENT RECORD
Were existing septic components al andoned as part 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: 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 instalation approval and related permits.
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❑ 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 an/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(land 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 /further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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Signature of Installer Date
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Printed N me of Signee P� �o ti� +�
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MASON COUNTY PUBLIC HEALTH Ark, 47- i41
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The undersigned approves this Installation Report and o CENDY E.WAITE• "
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Record Drawing on behalf of Maspn County Public r/ LICENSER DESIGNER
Am.oloww . loom as".v..g/
Health: ExPiRts 05na
Rli\tArnie COI 0 (z(
Signature of Environmental 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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MASON COUNTY ENVIRONMENTAL HEALTH
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ORIFICE SPACING 5
Lateral# Length Length Orifice # Distance from Distance from end Length#
# (Feet) (Inches) Spacing " Orifices feeder line of end of lateral
1 38 456 60 8 1.5 1.5 38
2 34 408 60 7 2 2 34
3 30 360 60 6 2.5 2.5 30
4 34 408 60 7 2 2 34
136 1 28 136
TRANS LENGTH 25
GPM 1652
K (2" SCHEDULEN 40) 284.5
FRICTION LOSS 0.1291833
Squirt 2
Elevation difference 6
TDH 8.1291833
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APPROVED
O C T 2 1 2025
MASON COUNTY ENVIRONMENTAL HEALTH
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DRAINFIELD LAYOUT
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l44= it.• SEP 2 5 2025
MASON COUNTY ENVIRONMENTAL HEALTH
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X1=CLEANOUT/OBS PORTS(B) .a p•/ a/sta/.6 s,� j. *k_' `116"F'.
X2=D BOX/VALVE BOX t • a
i X3=Check Valves CO T t n 'o • ►1 E�WAIT E'\ ,....
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X4=Flow Control Valvesi., r, �i
X5=Soll Logs paf�' ^' L.a iv e Oak
APPROVED
O C T 2 1 2025
MASON COUNTY ENV1RONMENTAL HEALTH
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