HomeMy WebLinkAboutSWG2025-00082 - SWG As-Built - 11/19/2025 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00082 Parcel # 22126-44-00080
Applicant Name Richard &Tara Parker
Subdivision (Name/Div/Block/Lot)
Applicant Address 3261 E Harstine Island Rd
City, State, Zip Shelton, WA, 98584 Installer Name Skinner Construction
Site Address same-add ADU Designer Name Arrow Septic Designs, Inc.
INSTALLATION CHECKLIST
in Full Only ❑ Repair ❑ Other Full System Installation ❑Tank(s)Only ❑ X02
System Type Oscar X02 treatment Type
>5 ft. from foundation? - \\-
� - - ❑ N/A Q YES ❑ NO
> ft. from wells? - ❑ ❑ ❑
50 tStS � ❑>50ft. fromsurfacewater? - - - - - - �v-Ib1 - - - - ❑ ❑
Z ❑ U ❑
� Cleanout between building and tank? ❑ ❑
V Tank baffles present? - ❑ CI ❑
a24" access risers over each compartm r - - - - El ❑
W Effluent filter installed?- ❑
Septic tank capacity (working)
1,000 gal Manufacturer 2-comp Evergreen Precast
— O D-box water level and speed levelers used? - - ❑ N/A ❑ YES NO
❑
�J
O Manifold/D box accessible from surface?- - - - - ❑
00 Z Check valves installed? - ❑ 0 ❑
CIQ 1" Schedule/Class 40
E Transport Line Size
Bedrooms installed (check one) ■❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A ❑j YES ❑ NO
0
>100 ft. from wells?- ❑ 0 ❑--1
>100 ft. from surface water? -
- El 0 ❑
u. >10 ft.from potable water lines?- ❑ 0 ❑
Z
4 > 5 ft. from property lines and easements?- - ❑ I El
Q > 30 ft. from downgradient curtain/foundation drains? - El � El
Drainfield level and observation ports present - CI
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A IN YES ❑ NO
Pump tank capacity (flood) 1,000 gal Manufacturer 2-comp Evergreen Precast
z
a 24" access riser(s) and accessible from surface?- - CI ill
F- - a El
Alarm or Control Panel Installed? ❑ a ❑
E Control Panel equipped with Timer/ETM /Counter- El
a Pump installed in ❑ Bucket or ❑ On Block or ® Other
on bottom of tank
1 Pump Make/Model AY McDonald E-30 0 Floats or ❑ Transducer
a Tank draw down
-- in/min Pump capacity 30 gpm Squirt Height -- ft
Pump on time 30 sec Pump off time 3 min Daily flow set at 240 gpd
L,paatetl 8212018
Mason County OSS Installation Report pg. 2
Parcel# 2--2 —_y_'`-- 0`�0$
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project?
_ 0 YES II No
If yes, please describe: � YES NO
Were all components pumped out and properly abandoned per WAC246-272A-0300? -
RECORD DRAWING
• This is a permurent record and must be accurate and descriptive enough to relocate in the need of maintenance acttvldss and future development Fypic i Record
Drawings contain: Dralnfrdd&manifold orientation&layout.Septoipump tank location.North arrow,reserve drarfidd,existing and proposed bang•loon of wells,waterlines,
welts,observation ports,clear outs.and other maintenance access poets. Incomplete Record Drawings may create additional delays'n final itsLaAation approval and related Permits.
RSL_, 0\-0S.V(L&-
111 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 a!!
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
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
,2,\o-,�,�_A - Av c.�-- l`��°I—ZS
Signature of Installer Date (t
`-= NL v E.L S4.< l tiI kt Z is
.
Printed Name of Signee of a `1,
MASON COUNTY PUBLIC HEALTH I(1=`� a, d!r`h
The undersigned approves this installation Report and sIi .
Record Drawing on behalf of Mason County Public t���s. PAULrisiA JOYJ49JOHNSON cy
Z*. ..
Health: 4 s 'c c5 c _ •
\ �s
p-,-„,0,ecol sI31-?_-
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 B121rz°16
sallalnillsi .-- '
• • • . • • •
It..en
0 Control Panel with Audio-Visual Alarm •
• APPROVED • .
3 Cleanout 1
3 1,000 GalLon Septic/Aeration Tank ..7:/5) .
2-Corapartment with au-diffuser DEC 0 8 2025
Q.Ct-.r4PAULA 0i:2141807H NSI ../...:4/1,k ••
a 1,000 Gallon Cla /P
erump Tank MASON COUNTY ENVIRONMENTAL HEALTH
2-Compartment "'" t NO,
RET .7 :
: 41
0 Headworks
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3 OSCAR X02 Mound Drainfield . ON
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