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Home My WebLink AboutABANDONMENT RECORD - SWG Inactive - 1/12/2026 , ' 14 7Pc15-eaviAY n1g-O Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number ..FkroG' ( q ok.S lA It Parcel# 319083300030 Applicant Name Taylor Shellfish 9 mob tz5Subdivision (Name/Div/Block/Lot) Applicant Address 1O SE L4ACV\ 'Zak Lot 1 , 1.--01-Z , (---0-1-3 ; LOT` City, State, Zip Shelton WA Installer Name Wes Graves Site Address 141 S.E. Lynch RD Designer Name N/A INSTALLATION CHECKLIST ■ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pretreatment Type >5 ft. fr•. foundation? - - O NIA ❑ •S ❑ NO >50 ft. from ells? - - O g O Z >50 ft. from su.ace water? - - O O O H , Cleanout betwee •uilding and tank? - - O O O ✓ Tank baffles present: - - O O O P i 24"access risers over a ch compartment?- - M O O W Effluent filter installed?- - i O O ` Septic tank capacity (working) gal Manufactur-' 3 D-box water level and speed leveler used? - - ❑ N/A ❑ YES ❑ NO . oO Manifold/D-box accessible from surface'- - O O O c9 Q Check valves installed? - - O O O 2 Transport Line Size Sch-•ule/Class • Bedrooms installed (check one) ❑ 2 El 3 \ 4 ❑ 5 ❑6 El Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO O ; >100 ft. from wells?- - ❑ O O W >100 ft. from surface water? - - O O O IT. >10 ft. from potable water lines?- - O O O Z > 5 ft. from property lines and ease• ents?- 0 0 ❑ `d > 30 ft. from downgradient curta'-/foundation drains? - - \ O 0 fa • Drainfield level and observati• ports present - - ■ O ❑ ❑ Graveless chambers -r O Clean gravel used? (check one) Proper cover installed o•er drainfield? - O O O Pump tank setback- consistent with septic tank?- - O N/A O YES O NO • Pump tank cap-'ity(flood) gal Manufacturer B24"access ri •r(s)and accessible from surface?- - O O O ~ .Alarm or Control Panel Installed? - O O O a - ? Control 'anel equipped with Timer/ETM/Counter- - O O O a- Puma installed in ❑ Bucket or O On Block or O Other & Pimp Make/Model O Floats or O Transducer • Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 , Mason County OSS Installation Report pg. 2 Parcel# 319083300030 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑� YES ❑ NO If yes, please describe: Decomission per WAC Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 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 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. I 1 )/ Z/ 3 17H 0 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 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. �p� 12-23-25 Signatu of Installer Date • Wes Graves Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: (17j4 Signature Signature of Environmen al Health 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 • THU STON-MASON HEALTH DISTRICT /3,0,Division of Sanitation Receipt 5th and Birch Court House Annex Shelton, aashington Olympia, dashington Phone: 426-4407 Site Ins ction'; ' Phones 352-4851 Lx. 84 APPLICATION TO CONSTRUCT OR ALTER AN INDIVIDUAL SE ACE DISPOSAL SYSTEM (Application required for each installation and/or major repair ) Buyer or ,!/ ,� f C6 / 7 • Property Owner //Gt?m e (24 //;poj: '4e1� Phone ' � 1 p Y .. . Mailing Address /u 'Af^ fowr,-e City \-0e,/,:if State\A/arkZip p Builder S~ <f o v1/h el- Address Li T q Location of r roperty, including: Lot: Block Other v w J S� ' 1 S.. -w Mailing Address of Site Detailed directions to•site:.1,��S' / -3 ' ,/ an? cFom dn- r/ Property Commercial Size Residence ,{of Bedrooms,...Basement Type--"„'r,,,^� dater Supply: Depth of .:ell r/ Spring Other Is well or body of fresh water within 105-Mt of sewage system? Is salt water supply within 50 feet of sewage system? Septic Tank 1;h6ee gals. Drainfield length ft. Trench widths,_„_,. . (Refer to Table 1 of 1 tin) And/or system other than above (Refer to Table 2 of Bulletin) Is garbage grinder being installed? Is contractor installing septic tank?_....._ Drainfield? NName of Sewage Contractor (Sewage Contractor must be licensed by Thurston-Mason Health bis iict THE UNDERSIGNED hereby appli=: for a permit • construct( ), alter( ) and/or modify( ) a sewage system on, a• _ ,, -rt accordance with the Bulletin. Applicant'a Signature - Mailing Address tuas gton S a e . o He e . . enti ' eptic Tan_,__k,system for your Home" for minimum requirements. • rJot to be filled in by Ap licant Permit ‘544g4 Fee?o`*Date Issued 411-49-.-S-G 9 gY • Area Sanitarian REMARKS: Date Approved_ ,Appr'o'ved by- Printed From Mason County OAS �s��rnG Printed from Mason County DMS G 4• `.. 0 , 4. 17,,,t ,.___ .... ° b • O. . ... Q Q . . .. cal ` .. . CM . ate. J c LT._ • . . . . . . .. O c+- i . . .. .. • • • t `o -------:!..t ok ..4 j Printed From Mason County DMS - , . . Printed from Mason County DMS TANK PUMPING REPORT Site Name: Location: 141 SE LYNCH RD(Space#s 1,2,3,4) Service Company: Shelton Tax ID: 319083300030 AAA Septic LLC Use: PO Box 1460 Shelton,WA 98584 360-427-6110 Serviced:12/23/2025 by:Wes Graves Submitted 01/09/2026 by:Wes Graves Dump Location:Bio-Recycling Jurisdiction ID:319083300030A COMMENTS lots 1,2,and 4 did not need pumped they were empty pumped lot4 and decommissioned all 4 tanks after TANK:Septic Tank-1 Compartment Space 1 Tank Pumped: NO Tank Size(Gallons)(Number only,no text): 1000 Effluent level within operational limits(if NO explain in comments): NO Deficient Total Gallons pumped from tank(Number only,no text): 0 Effluent returning back into tank after pumping: NO • Tank depth below grade(inches): 24 Access Risers installed to grade(N/A if not present): NO Tank Construction Material: Concrete Tank Condition Good: NO Deficient Baffles in good condition(N/A if not present): YES Effluent screen cleaned(N/A if not present): N/A Effluent surfacing around site components(N/A if not checked): NO Tank abandoned after pumping: YES Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 0 ANK:Septic Tank-1 Compartment Space 2 Tank Pumped: NO Tank Size(Gallons)(Number only,no text): 1000 Effluent level within operational limits(if NO explain in comments): NO Deficient Total Gallons pumped from tank(Number only,no text): 0 Effluent returning back into tank after pumping: NO Tank depth below grade(inches): 18" Access Risers installed to grade(N/A if not present): NO Tank Construction Material: Concrete Tank Condition Good: NO Deficient Baffles in good condition(N/A if not present): YES Effluent screen cleaned(N/A if not present): N/A Effluent surfacing around site components(N/A if not checked): NO Tank abandoned after pumping: YES Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 0 ANK:Septic Tank-I Compartment Space 3 Tank Pumped: YES Tank Size(Gallons)(Number only,no text): 1000 Effluent level within operational limits(if NO explain in comments): YES Total Gallons pumped from tank(Number only,no text): 1000 Effluent returning back into tank after pumping: NO Tank depth below grade(inches): 24" Access Risers installed to grade(N/A if not present): YES Tank Construction Material: Concrete Tank Condition Good: YES Baffles in good condition(N/A if not present): YES Effluent screen cleaned(N/A if not present): N/A Effluent surfacing around site components(N/A if not checked): NO This report indicates certain characteristics of the onsite sewage system at the time of visit.In no way is this report a guarantee of operation or future performance. ReportiD:856893 View pump reports online at www.onlinerme.com Page 1 of 2 , Tank abandoned after pumping: YES Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 0 ANK:Septic Tank-1 Compartment Space 4 Tank Pumped: NO Tank Size(Gallons)(Number only,no text): 1000 Effluent level within operational limits(if NO explain in comments): NO Deficient Total Gallons pumped from tank(Number only, no text): 0 Effluent returning back into tank after pumping: NO Tank depth below grade(inches): 18 Access Risers installed to grade(N/A if not present): NO Tank Construction Material: Concrete Tank Condition Good: NO Deficient Baffles in good condition(N/A if not present): N/A Effluent screen cleaned(N/A if not present): N/A Effluent surfacing around site components(N/A if not checked): NO Tank abandoned after pumping: YES Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 0 • This report indicates certain characteristics of the onsite sewage system at the time of visit.In no way is this report a guarantee of operation or future performance. ReportID:856893 View pump reports online at www.onlinerme.com Page 2 of 2 ;,'!. ,. •11P 319083300030 X Q ,` * .45 F' i.. r ,:• .E : Show search results for 31908... t T • :): 4.•' 063300020 ono SEILYNCH RD UNIT#22 •; ` 141,SE'LYNt H RD UNIT#21 �' 141SELYNCH ' � UNIT#41 O' 141 SE LYNCH RD� t, f �°� RD UNIT #1� �. _ volt— . .r .,„ Y _ ' 141SE LYNCH RD UNIT#4i ° �{ 141 SELYNC� RD'UNIT #43 •- • gal SEL•YNCH RD UNIT:1.141 SE LYNCH RD UNIT #3 141 SE LYNCH RD UNIT #2 Aliiiit 51 "T.... •t�* ;:'rM1c.l+. .YT w @, vpv :r au a,... _ .,. 31908330g, 0 I, .aviiii". ...ki� ., -''' ''. :r