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Home My WebLink AboutSWG2020-0034 - SWG As-Built - 10/16/2025 DICE 71C rol CLEAR FORM88NOV Q 4 ?r]75 I1 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEAL APPLICANT/ PERMIT INFORMATION Y.------------ Permit Number SWG 2020-00314 Parcel # 22018-50-00100 Applicant Name Shawn Green Subdivision (Name/Div/Block/Lot) Applicant Address 8312 Sierra Dr Timberlake Div 1 Lot 100 City, State, Zip Edmonds WA 98026 Installer Name Buzz Workman Site Address 631 E Timberlake Dr E: Shelton Designer Name Tom Weaver INSTALLATION CHECKLIST II Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Gravity Pretreatment Type >5 ft. from foundation? - - ❑ N/A II YES ❑ NO >50 ft. from wells? - - Cl II ❑ Z >50 ft. from surface water? - - CI II CI H Cleanout between building and tank? - - CI II CI0 Tank baffles present? - - ❑ IN ❑ a24" access risers over each compartment?- - ❑ II ❑ W Effluent filter installed?- - ❑ II ❑ U) Septic tank capacity(working) 1,250 gal Manufacturer Hagerman Ol D-box water level and speed levelers used? - - ❑ N/A 1111 YES ❑ NO OJIN LL Manifold/D-box accessible from surface?- - ❑ mZ Check valves installed? - - ❑ ❑ 1111 OQ 2 Transport Line Size 4 Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 II 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other //2. LAI° � >10 ft. from foundation?- - ❑ N/A ❑ YES II NO O >100 ft. from wells?- - ❑ II ❑ W >100 ft. from surface water? - - CI II CI u. >10 ft. from potable water lines?- - ❑ ® ❑ Z > 5 ft. from property lines and easements?- - CI I] CI d > 30 ft. from downgradient curtain/foundation drains? - - ❑ U ❑ O Drainfield level and observation ports present - - ❑ II ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ II ❑ Pump tank setbacks consistent with septic tank? - - ® N/A ❑ YES ❑ NO Pump tank capacity (flood) gal Manufacturer < 24" access riser(s) and accessible from surface?- - IN ❑ ❑ O. Alarm or Control Panel Installed? - - Ill ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ® ❑ ❑ D d Pump installed in ❑ Bucket or El On Block or It Other None a' Pump Make/Model or ❑ Transducer a_ a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8212018 Mason County OSS Installation Report pg. 2 Parcel# 22018-50-00100 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 111 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES II 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 drainfieid,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 end related permits. I 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 ali 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. (/vty,� 6/26/25 Sy dAtAA.A.A.: . i Signature of Installer Date •i •\-P Or /-? -1.___.----'• • Buzz Workman j -,w o i,, Printed Name of Signee ? .1'� q•. sh MASON COUNTY PUBLIC HEALTH :r 5100333 •) ie THOMAS E.WEAVER' % The undersigned approves this Installation Report and % ^;� "sro. i NEa • " I. //6jZ 1 Record Drawing on behalf of Mason County Public -� Healfh:1Q___ii-\.0AAA/ Vil i ('SI Signature orEnvironmdntat Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated erztrlote 2 6 W e OR 4ril� 78.19' APPROVED NOV 05 2025 - MASON COUNTY ENVIRONMENTAL HEALTH -- MET sL#1 -O-22'Sand Loam -_, 22 36"Med Sand Loam 36"Compact 50' Attenuation Zone SL#2- 0-34"Sand Loam 34"compact SL#3- 0-36'Sand Loam • 36"Compact As-Built X SL#3 100% Reserve ig gi ii k XSL#2 • 4 $ )� SL#1 4 ( T------------__________" _ fe Six ole ,, D-Box h- Three Bedroom ' `o Manf Home / . / + 28' — 20'7-. i' i1 co •,7-s- 'J 4 8' // 1.-'; ' I „lit g1M333 d j °- 71.1pwu5 E.WEl.VER'�. � <r_ � 20' GN a.. -..."- /V/6/2 5- . We ~ 38.98' 76.78' Timberlake Dr