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HomeMy WebLinkAboutSWG2025-00306 - SWG As-Built - 11/18/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00306 Parcel # 32023-47-00080 Applicant Name Jtt-t-tKY. Kuu <! vv Subdivision (Name/Div/Block/Lot) Applicant Address 323 SE STOTSBERRY RD City, State, Zip SHELTON WA 98584 Installer Name MICAH HALVERSON Site Address 323 SE STO 1 S ERRY RD Designer Name MiCAl-i HALVERSON INSTALLATION CHECKLIST ❑ Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type A(� Pretreatment Type >5 ft. from foundation? - /C }� - - - - El N/A kJ YES El NO >50 ft. from wells? ��-�'\� �-j- - - \ - - - ❑ ® ❑ Z >50 ft. from surface water? - - - - % s. - - - -31��3- - - - - - [1] ® ❑ Q Cleanout between building and tank. �" - - �-, - - 0 - ❑ ❑i7 ❑ U Tank baffles present? - '.\ - - - - - - - - ❑ ® ❑ F— 24" access risers over each compartment?- - - [] 0 ❑ W Effluent �filter installed?- - - i �•�- - ❑ 0 ❑ Septic tank capacity (working) 1050 gal Manufacturer SOUND PLACEMENT 5 D-box water level and speed levelers used? - / ❑ N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ ❑ ❑ co Check valves installed? - - - - ❑ ❑ ❑ 0< Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - • - ❑ N/A ❑ YES ❑ NO 0 >100 ft. from wells? - -- - - ❑ ❑ ❑ W >100 ft. from surface water? - - El ❑ tL >10 ft. from potable water lines?- - ❑ ❑ ❑ Z > 5 ft. from property lines and easements?- - - - - - - - - - - - - ❑ ❑ ❑ a a > 30 ft. from downgradient curtain/foundation rains? - - ❑ ❑ ❑ • Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tank capacity (flood) gal Manufactur Z 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ f— a Alarm or Control Panel Installed? - - El El 2 Control Panel equipped with Timer/ETM /Counte - - ❑ ❑ ❑ n a Pump installed in ❑ Bucket or ❑ On or ❑ a• Pump Make/Model Floats or ❑ Transducer O. a Tank draw down in/min Pump capacity gpm Squirt Height ft I Pump on time Pump off time Daily flow set at gpd Mason County OSS Installation Report pg. 2 Parcel# 4? �O'"fl ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - © YES NO If yes, please describe: PI_t .^PFn AA^!n Ft! L Fn Vnr1TH SO!! (P.ACKGn ccDT!r`TARN Were all components pumped out and properly abandoned per WAC246-272A-0300? - - © YES 111 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. LJ� AN 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 furthe edify that all information contained on this 1 further certify that all information contained on this form d attached Record Drawing is accurate. form and attached Record Drawing is accurate. ll/i keys ign ture of Installer Date t \_4 Ci( (-k i k PrNAC.Vi� \\-5 Printed Name of Signee k` MASON COUNTY PUBLIC HEALTH ‘. • f The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public 5100409 ` 4. IMICMI Twat t ALVISMOM Health. DEAR Qiy•ukivufAY''' It If VI t'YOIQ''r..nail RI_kra 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 812 112 0 1 8 I'L..- . / / "•.....„.„.....b.p..........„,.............,...:3 • / New 3 bedroom home �` / a / fiP • / T 7 / / / 4J-I -1500 gel 2 compartment L . Traffic rated tank • I / / coeiier•u mace'ace' *2 i5 220v pump In second compartment p trimmed ed web:Hine / I / ..-- 1---1V— ' i IfJ `\ // ..,,,I \1y / �. N I o i7 t } I i k3 C O ; CD co O 1 i f< WELL ! C 1 1 4 A I , 1 -.1, Power pole �Q 1 r— I L o 0 , H hr \ / ` l / i \ I / ' I `.. ,_ a I // .,.n i tN s . ___ II— ) neighbors well 50 NN. lrl location over _-.._._..,.... \. r'Ivt:w \ •q ,!1s..7144‘1/4,ti i/ r ,:„. 4"sleeve under drt *j .,,,,,,, ' ..44 l7 rl‘11:6,%, is-NNN. / 1 or' � ` + s,oaoo art ,! N N / - MICA DESIGNER 4. N • Abandon Cracked Septic tank ' i Per WAC246-212A-0300 7 I i21)4t.4"1›, e �. I Asbuilt for Jeffery Tank only nly permit .irrG 2015-000 4000eo _• parcl# 32023-4Printed From MasdnCOUt ' ? Printed from Mason ounty D '.. 4 Hole con d-bcx Blau Sound Placement 105�___ male'! 1 zt30' a Compartment Septic tank I with speed levelers 4"ASTM 3034 Transport Pipe 30. I 0' 15' 85' 60' i