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HomeMy WebLinkAboutSWG2022-00449 - SWG As-Built - 12/29/2025 , Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00449 Parcel# 420222100010 1 Applicant Name Daniel &Randi Hunter Subdivision (Name/Div/Block/Lot) Applicant Address 4700 West Shelton Matlock Road City, State, Zip Shelton, WA 98584 Installer Name Brandon Thompson Site Address 4700 West Shelton Matlock Road Designer Name Jim Hunter INSTALLATION CHECKLIST I. • Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other i System Type 2BR GRAVITY Pretreatment Type I >5 ft.from foundation'? - r--= ❑ N/A 0 YES ❑ NO >50 ft.from wells? • - \\ ❑ IN 0 >50 ft.from surface water? - . D 0 El Cleanout between building and tank? - `�05-- ❑ M] 0 U• Tank baffles present? - r - -C' e - 0 0 , � }= 24"access risers over each compartmen - - ® 0 a: •W• Effluent filter installed?- - - - ❑ [] ❑ N : .' Septic tank capacity(working) 125 al Manufacturer INFILTRATOR o D-box water level and speed levelers used? - - ❑ N/A J YES No kO Manifold/D-box accessible from surface?- • ❑ a- art Check valves Installed? - -- ❑ o a Transport Line Size 14" Schedule/Class .7-Z ttck Bedrooms Installed (check one) © 2 0 3 0 4 0 5 0 6 0 Commercial/Other >10 ft.from foundation?- -- 0 N/A 0 YES ❑ NO cr. >100 ft. from wells?- - 0 0 0 4 W .>100 ft.from surface water? - - 0 ® ❑ ti >10 ft.from potable water lines?- - 0 ® ❑ 2 >5 ft.from property lines and easements?- •- 0 ® 0 iY > 30 ft.from downgradient curtain/foundation drains?• - 0 II 0 G Drainfield level and observation ports present - - 0 Pri 0 ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover Installed over drainfield?- - 0 ® ❑ 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?- - 0 ❑ ❑ Alarm or Control Panel Installed? - a - 0 0 III d Control Panel equipped with Timer/ETM/Counter- - © 0 ❑ .a Pump installed in Bucket or ❑ On Block or 0 Other 1 gPump Make/Model ❑ Floats or 0 Transducer "Q Tank draw down In/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 0/21/2018 K Mason County OSS Installation Report pg. 2 Parcel# 420222100010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES ❑ 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 contan Dramtiekt&manifold onentation 8 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. [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 all information c ntained on this I further certify that all information contained on this forma ac cord wing is accurate. form and attached Record Dra ing is ace fbte. 12/12/2025 Signa rifS of Installer Date ' j 2 _22 BRANDON THOMPSON ,t Printed Name of Signee 4.46x o'"^ram 4 • MASON COUNTY PUBLIC HEALTH two te. �� The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public JAILS ,NI ER 47 LICFPiSFr)t)ESIr,,NcR Health: '- (t41 5' FxprDtS. ov21r24 i Signature of Environmental I ealth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8,21/2018 IIIIL • r— c q ? II , 'off s +1 o fD 2i — i r J N h M 8 d N r rf. N 1 , ,qa d f i r �z1 l/ill t .t 8 M gL • " u . - 2. ) - 1 in 1'4 / / :.' .. < ..) 8 t o ' rn =t - /, IIIll iIr I (,._ E d 8 i / ---1— - 1.. i • . � ---. . ,aye ! /'' . r/ i i d U —/ 6- �jj c� • h P. i ��S'i .rc "CS9: o• 1 x 0 x, n Rov Et o dip p :,l • . DEC 29 2025 �COUNS�ENVNM�NTAI.�EA1.Sl1 rr,Aso RED IRO . ° $' i 1 i In )fi J yrer! j� 1d/ ..?.I. . rqi0 .- -'- -4r --; --- iFf. tg- ,°o. A w ►•. - 4 ley N a`