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Home My WebLink AboutSWG2025-00130 - SWG As-Built - 11/19/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG ZOZ'-- 00 1 S U Parcel# 222( Z_ .`5"-0 -0 2)Uoq Applicant Name 4.1SG.E..1; 70k)ytbCr_,5- Subdivision (Name/Div/Block/Lot) Applicant Address T.O, 3o% i?J7 Z.LvCb4-- U L o i 9 I O City, State, Zip I'o�-r UdLc-t}f>Z- WA 8566 Installer Name -oti Virrr"v--k- �_f lip f - Site Address L ry Y$ 't-� his_►—F�r:z-WA cl ft 528 Designer Name '-)q T 61--'/L,J INSTALLATION CHECKLIST Full System Installation 0 Tank(s)Only 0 Drainfield Only 0 Repair 0 Other System Type 'd:'rvC_SS nf=r-)Fr-c F-R Pretreatment Type >5 ft. from foundation? j ❑ NIA Y s ❑ NO >50 ft.from wells? - I,�- _ r eilypo-- ❑ lJ ❑ Z >50 ft.from surface water? - /' /- f ❑ FQ- Cleanout between building and tank? / oCl� ❑ ❑ o Tank baffles present? - I� ,ti,.- - - - - - 20____ ❑ V ❑ d 24"access risers over each compartment - - - [1] ❑ fW Effluent filter installed?- \ ❑ El Septic tank size /ZSi_) gal Manufact— ftC R 6&\N 0 D-box water level and speed levelers used? • ❑ NIA ❑ s No 00 Manifold/D-box accessible from surface?- - ❑ ❑ CaZ Check valves installed? - - 0 0 D7 a2 Transport Line Size I f hedule/Class 0`3`1- Bedrooms installed (check one) ❑ 2 104 0 5 ❑6 0 Commercial/Oth >10 ft. from foundation?- ❑ N/A k r NO CI El>100 ft,from wells?- - 0 W >100 ft.from surface water? - - ❑ Fc.. ❑El ti >10 ft, from potable water lines?- - 0 ❑ ? >5 ft. from property lines and easements?- - El El Eld > 30 ft.from downgradient curtain/foundation drains? - - 0 Drainfield level and observation po present - - 0 ( ❑ 0 Graveless chambers or Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ a le 0 Pump tank setbacks consistent with septic tank?• - ❑ N/A YES ❑ NO ZPump tank size (� gal Manufacturer i4v�lL�'�'`} Q 24"access riser(s)and accessible from surface?- - 0 ❑ I- a. Alarm or Control Panel Installed? - - 0 0 2 Control Panel equipped with Timer/ETM /Counter- - ❑ E7 ❑ n n- Pump installed in 0 Bucket or ❑ On Block or ElOther Oki -J Q, Pump Make/Model O!_£rr o O -3OO6l . Floats or ❑ Transducer R...a.. Tank draw down /I A 5 ' in/min Pump capacity SO qpm Squirt Height 5 1 1- ft Pump on time 1 -e1.J Pump --'Y'off time 2--/lac/,z5 Daily flow set at 0 qpd R.-' '•t-AN - 2 d GJ I>!'War N rt(, id(kt-• Updatod 812112078 E rr' l-:-rAr�i,� : q l 0%c G': 2-.c, Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES Xi NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? • - 0 YES 0 NO RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to re-locate in the need or maintenance activities and future development. Typical Record Dravdngs contain Draintold&manifold orientation&layout.Septic/pump lank location.North an-ow.reserve droinfiele.existing and proposed buildings,location of wells.waterlines. wells.observation ports.claanouls.and other maintenance access points. Incomplete Record Drawings may create additional delays in final Installation approval end related permits. gRecord 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 f an attach d Rec rd Dr ing is accurate. form and attached Record Drawing is accurate. Il D '-25 'Dkvci o Pc, 6/ LI,J Signature o stellar. i Date Pa r r+ Printed Ne,4e of Signee `` MASON COUNTY PUBUC HEALTH .0. The undersigned approves this Installation Report and Wit, 0! 1+. Record Drawing on behalf of Mason County Public . ..tx-,iasti► ,,.. COINS?:10641 Health: 11110;c I PC J /a/Z6 Zc Signature of Envlronm ntal Health Specialist Date (stamp, signature and date) Ili THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated er21/2018 II 1 A 400 Valley Ave NE ate: 10l6125 PORT V � 1� � Puyallup,WA98372-2516 Time: 10:28 SAND & GRA ELAmmo (253)833-3705 Ticket#: 238378 vnvw.miles.rocks I Plant Time out: 1 II Job Time in: ( Job Time out: (I Plant Time in: I 507 SHINE Units Pounds Tons Total Tons —I ,660 �,66 08300 RON HEMLEY SEPTIC INSTALLATION Tare Gross 50 500 0 120829 JOB 110 E ELENORE m ELENORE BELFAIR Net 24,380 12.19 27•05 n o 1040 SAND FILTER SAND TN a Carrier TEMPORARY VENDOR Sub Total Truck# TMPHT Sales Tax Driver Total Release-Customer assumes all responsibility for damage inside the curb property line to persons and property. Any applicable Towing and Standby Charges are the Customers responsibilty. L� Received by: v ORCHARD400 Valley Ave NE / I6f25 PORT Puyallup,WA 98372-25 ime: 7:49 . unimmummomillammomiliumim (253)833-3705 I Ticket#: 238368 www.miles.rocks Plant Time out: Job Time in: Job Time out: l Plant Time in. f 0 c 1 507 SHINE Units Pounds Tons Total Tons -0 08300 RON HEMLEY SEPTIC INSTALLATION Gross 56,000 0 26,280 m 120829 JOB I 110 E ELENORE Tare ELENORE I LBELFAIR Net 29,720 14.86 14.86 X 0 1040 SAND FILTER SAND TN 0 Carrier TEMPORARY VENDOR Sub Total , Truck# TMPHT Sales Tax . Driver Total Release-Customer assumes all responsibility for damage inside the curb property line to persons and property. Any applicable Towing and Standby Charges are the Customers responsibilty Received by: Si/ PART ORCHARD 400 Valley Ave N Date: 10/7t25 Puyallup,VVA 1 Time: 12:22 SAND & GRAVEL (253)833-3705 Ticket#: 238401 iiimilloommillisaulliim www.miles.rocks Plant Time out: Job Time in/ Job Timl out: Plant Time in: n C 507 SHINE Units Pounds Tons Total Tons O 08300 RON HEMLEY SEPTIC INSTALLATION Gross 50,640 —I �� 121098 JOB I 110 ELEANOR PEAK Tare 26,040 m I IBELFAIR Net 24,600 12,3- 26.52 n 1040 SAND FILTER SAND TN o Carrier TEMPORARY VENDOR Sub Total Truck# TMPHT1 Sales Tax Driver Total Release-Customer assumes all responsibility for damage inside the curb property line to persons and property. Any applicable Towing and Standby Charges are the Customers responsibilty. Received by: 400 Valley Ave NE4e: 'I Dat 10/7/25 simmilmilmommillmomosommommilm PORT ORCHARD Puyallup,WA9837 1 Time. 7:23 S A N D & G R A V E L (253)833-3705 Ticket U. 238394 www.miles.rocks Plant Time out: Job Time in: Job Time out: Plant Time in: n C ® Pounds Tons Total Tons CD 507 Gross 54,480_— 08300 RON HEMLEY SEPTIC INSTALLATION 0 26,040 _— m 121098 JOB 110 ELEANOR PEAK ® - 28,440 14.22 14.22 IIIIIIIIIIIIIINIIIIIIIIIIIIIE 1040 = SAND FILTER SAND TN n ht En TEMPORARY VENDOR Sub Total— IlErSales Tax— Driver MININIMIII Total Release-Customer assumes all responsibility for damage inside the curb property Vine to persons and property. Any applicable Towing and Standby Charges are the Customers responsibilty. [1:=1 Received by 400 Valley Ave NE te: 10/6/25 T ORCHARD PiNallup,WA 983 1 Time: 12:17 SAND & GRAVEL (253)833-3705 Ticket#: 461301 W,w.miles.rocks Plant Time out: Job Tim in: Job Time out: Plant Time in: 503 SIDNEY PIT Units Pounds Tons total Tons 0 08300 RONHEMLEYSEPTICINSTALLATION Gross 51,460 120947 JOB 110 E ELLINOR PEAK PL Tare 25,700 O BELFAIR Net 25,760 12.88 12.88 3 m 1135 1 1/2"WASHED ROCK TN 0 0 a Carrier TEMPORARY VENDOR Sub Total Truck# TMPH37 Sales Tax Driver Total Release-Customer assumes all responsibility for damage inside the curb property line to persons and property. Any applicable Towing and Standby Charges are the Customers responsibilty. Received by: i — \ 400 Valley Ave NE # Date' 10/705 PORT ORCHARD Puyallup;WA9837 51S Time: 14:15 SAND & GRAVEL (253)833-3705 Ticket#: 461336 www.miles.rocks t Plant Time out: Job Time in Job Ti e L . Plant Time in: 503 SIDNEY PIT Units Pounds Tons Total Tons 0 08300 RON HEMLEY SEPTIC INSTALLATION Gross 52,100 07 121267 000786 110 E Ell NOR PEAK PL Tare 25,340 O 110 E ELLINOR PEAK PL BELFAIR Net 26,760 13.38 13.38 M — 1135 1 1/2"WASHED ROCK TN 73 n 0 -n *c Carrier TEMPORARY VENDOR Sub Total Truck# TMPH37 Sales Tax Driver Total Release-Customer assumes all responsibility for damage inside the curb property line to persons and property. Any applicable Towing and Standby Charges are the Customers responsibilty. Received by: A t4 • 0"' c. a, 0 r / /� _ -- --i. i'�� RESERVE AREA z 4 �/ r- w0 = ca o m m x 0ODX \ I S o S W IN �� m o -o 1 o iv O Cr, t--f o 0 "O 9'X': BOTTOMLESS • O O a D y S D FILTER CO O` 0 0 `i 1(ANO lit" X 25'BOrro& SS i FILTER O T r � �rn i D >n C!) 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