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HomeMy WebLinkAboutSWG2025-00457 - SWG As-Built - 12/19/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00457 Parcel # 32005-50-00029 Applicant Name Sherl n Lowe Subdivision (Name/Div/Block/Lot) Applicant Address 50 E Hicko Place Oak Park!Div 2/Lot 29 City. State, Zip Shelton, WA 98584 Installer Name Maples Excavating Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only El Repair ❑Other System Type Sand-Lined Pressure Bed Pretreatment 4� N Type ❑ N/A (�YES ❑ NO >5 ft. from foundation? ��� - - ❑ 0 ❑ _ _ _ >50 ft. from wells? - ❑ ❑ Y >50 ft.from surface water? - - - - 1 -DK- 1 -91025 ❑ C 0 Z . - - - < Cleanout between building and to ! ❑ . ❑ U Tank baffles present? �•`� ❑ ❑ a24" access risers over each comp- a -ais� ❑ El W Effluent filter installed?- Exn Septic tank capacity (working) 1200 gal Manufacturer - ❑ N/A ❑ YES El NO 0 D-box water level and speed levelers used? - 0El ME DO Manifold/D-box accessible from surface?- ❑ 0 ❑ o0Z Check valves installed? 0<C 2" Schedule/Class 40 2 Transport Line Size 3 4 0 5 El 0 Commercial/Other Bedrooms installed (check one) iffiv....p - ❑ N/A ❑ YES 0 NO >10 ft. from foundation?- 0 ❑ 0 >100 ft. from wells? El 0 0 W >100 ft. from surface water? - El El ❑ iy, >10 ft.from potable water lines?- El 0 Z > 5 ft. from property lines and easements? - -` N ❑ ❑ < et > 30 ft. from downgradient curtain/foundation drains? 0❑ il il 0 CI Drainfield level and observation ports present ❑ Graveless chambers or 0 Clean gravel used? (check one) ❑ ❑ Proper cover installed over drainfield?- _ � YES ❑ NO Pump tank setbacks consistent with septic tank? - ❑ N/A Hagerman Pump tank capacity (flood) 1,500 gal Manufacturer Z © a < 24" access riser(s) and accessible from surface? I- a. Alarm or Control Panel Installed? - ® 0 Control Panel equipped with Timer/ETM /Counter- 0 n- Pump installed in 0 Bucket or 0 On Block or Other pZoeller 185- 1hp 230v 0 Floats or 0 Transducer Pump Make/Model 5 ft a Tank draw down 2 in/min Pump capacity 52 _gpm Squirt Height Pump off time 6 hr Daily flow set at 480 gpd Pump on time 2.3 min updated 8mI2O18 Parcel# 3Z43.(::)'S -Mason County OSS Installation Report pg. 2 � COOL-9 ABANDONMENT RECORD _ ® Yes ❑ NO Were existing septic components abandoned as part of this project? - - - - please describe: [] YES ❑ NO If yes, + properly abandoned per WAC246-272A-0300? - - Were all components pumped out and p p Y RECORD DRAWING Typical Retard ve enough to re-locate in the need of maintenance activities and futur development e velolo a�otf wTUs,waterlines, This is a Permanent record and must nbe accurate aou descriptive in final proposed approval and related pennRs• pings ecnam: D2;r�eid&manifold orientation&layout.SeptiUPumP rank location,NoRh array',reserve Crairfieltl,epsting and proposed i -e-S-- $V4\--4Krkk 1111 wells,cbservauon pops.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNER/ENGINEER INSTALLER I certify that I installed the system in accordance with !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 dbeviations here have been cleared/approved by both the designer shown here have been cleared/app and Mason County Public Health and meet all State myself and Masonas Countyouty Public ubl i Health and meet all n and Mason County Codes. /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. Date Signature of Installer I .,•� t Aolk r� 'Zit. Printed Name of Signee , ti t r,t rJI MASON COUNTY PUBLIC HEALTH .1 li' f;Vl1. The undersigned approves this Installation Report and rrr s,oU3a9 Record Drawing on behalf of Mason County Public "..vc_PAULA Health: JOY JOHNSbN \ i tJ ' 2, v���l � FxP+l�s 12— 1 9 -Z,'S Signature of Enviror mental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8Qt2oia 42)i I 1c 3 . zs—,,, r v 1 F© 4a .... Q o pLbPl • J � w � ' . w o r � n r ., rt-,,, ---+ . © I ® O7. M , , -'-5 �cw• s � m cc— _�,a a 0 9 \-Cf. I / o 2, I Cam' • 0 6 �J.2ZA` Lf- fltL�V �`f/ 2Kc�IU 0 010 5LoM d' w i 12e K_e_,r. S c.A E. - za O Audio-Visual Alarm - xk uJ b to zo So 4,o ( Cleanout - A 9" _ l Ex 1sc t►I tr S Septic Tank �cS 2-Compartment— A'�`� £ L 0 Div 0 1200 Gallon Effluent Filter NBvJ QC. L- 3�,pSO"' bOb Zq O i500 Gallon Pump Chamber O � {�-tGl�oR� pL O�2) Tp`X t5s-tCI) 1D 'x3o, 6LTON `— RESEkJE D.". 6ED5 Q om- S't' 0( Q FA I LS o 20' X s o ' " -� CrR -ono D. --To BE A1DOtfED . r : p -tot) fir. ti. � L��T OLD D•�•� 'Z. o - t co" Lora^ s. A.-R_0-eTS, L µ5-1). SAAD ,: APPROVE- 0 �' � 1.�:. '�� e i r # _v i n DEC 19 20L5 '�, .. 5I00349 •.1) �, • �AUTA JOY JOkNSON �t� MASON COUNTY ENVIRONMENTAL HEA;"`, s �t \iGi�E RET r i:Is IZ-tq-Zs-