HomeMy WebLinkAboutSWG2023-00016 - SWG As-Built - 1/27/2026 1
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00016 Parcel # 32026-41-90143
Applicant Name kenneth adn amanda elliot Subdivision (Name/Div/Block/Lot)
Applicant Address 527 cascade ave
City, State, Zip shelton, wa 98584 Installer Name House Brothers Const.
Site Address SE trillium lane Designer Name Kevin Hughes
INSTALLATION CHECKLIST
li Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type Oscar x02 Pretreatment Type
>5 ft. from foundation? - - ❑ N/A ® YES ❑ NO
>50 ft. from wells? - �� � ` ❑
Z IN El
>50 ft.from surface water? - 1 T
- i. ❑ ® ❑
Q Cleanout between building and tank? - - _ - - -
H �1`1 ❑ O
U Tank baffles present? - s _ - ® El
acompartment access risers over each . V _
tLIJ W Effluent fitter installed?- ® El
❑ ® ❑-
Septic tank capacity(working) 1100 —ga Manufacturer HB Precast
J D-box water level and speed levelers used? - ® NIA ❑ YES ❑ NO
m u.
Manifold/D-box accessible from surface?- - ❑ ® ❑
Check valves installed? - El ❑
0 Z - :i
pQ
2 Transport Line Size 1 inch Schedule/Class Schedule 40
Bedrooms installed (check one) ❑ 2 ❑3 0 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- PP - ❑ N/A ® YES ❑ NO
O >100 ft. from wells?- _ ❑ ® C3-t >100 ft. from surface water? - - 1 _
/. v
L.T. ›10 ft. from potable water lines?- - - ,! ❑ 1ill 00
Q > 5 ft.from property lines and ease , '- - JAN-17- 2026- - ❑ ® El
Q > 30 ft.from downgradient curtain/fdditi eMPOPPRVIR IN(GIENTAL HEALT- ❑ ® ❑
Drainfield level and observation ports present - - - Etw - O ® El
❑ Graveless chambers or ❑ 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
Z _
H24" access riser(s)arid accessible trom surtace'?- - _. __ ❑ ® ❑
, Alarm or Control Panel Installed? - El S ❑
aControl Panel equipped with Timer/ ETM/Counter- - O Ill ❑
Pump installed in ❑ Bucket or In On Block or ❑ Other
• Pump Make/Model Liberty 290 ® Floats or ❑ Transducer
d Tank draw down in/min Pump capacity .,50ji,n gpm Squirt Height NIA-trc? ft
Pump on time NPa,suil Pump off time Nk 0.1(4( Daily flow set at 480 gpd
Updates 8/21.2C16
Mason County OSS Installation Report pg. 2 Parcel# 32026-41-90143
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - D YES ci NO
if yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - O YES 0 NO
RECORD DRAWING
This la 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 Dramfietd&manifold orientation 8 layout,Sephc/pump tank location.North arrow,reserve drain field,existing and proposed buiidings.location e`wells,waterlines,
wells,0hservabon ports cleanouts,arid other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
Submitted as standalone documents
MASON :N121
?.
C0UNTyENV1R , ,
CNMENTA' HEALTH
Jew
1:1 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
I certify that 1 installed the system in accordance with t 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 certifv that all information contained on this t further certify that all information contained on this
to and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
\ ."\VA-‘Z VA:Ari,
ature installer Date ��Hv
% �4'�ofWAs"ctroll.':7y
Printed Name of Signee a
1:1 CC
MASON COUNTY PUBLIC HEALTH '310 4 45227 �,�
The undersigned approves this Installation Report and %*e ctST `C.
Recotjt,Drawing on behalf of Mason County Public S�ONA ,11 4 1
�-��
Health - (Al 1 i\o/7,7c7
(..Sig{iat re 'f nvironmentai 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
1 I 2
Elliott Septic Record Drawing (4 Bedroom) � •
0
400ao W - iI
1T WETLAND 'y E
PROJECT INFORMATION \ BOUNDARY \
\ ♦ STREAM
Owner/Applicant: Kenneth&Amanda Elliott 1 \ I'y CENTERLINE )(wt r
527 Cascade Ave s I Y
Shelton,WA 98584 I I I I I I I''1 I\
� ; \ 2 rM 360-338-2198 ,‘
Site Address: XXXX SE Trillium Ln WETLAND —r ---\ _, ♦� T�;o '7'''',
\ ��T I -
Shelton,WA 98584 BOUNDARY / tour WE RADIUS p a p w T i
�m m W
/ ' P z
r Z sr N
Parcel#: 320264190143 3 ' '1i1 co
Parcel Area: 2.14 Acres(93,218 sf) STREAM / 1 �\\ 6
InIM ac
CENTERLINE /
I /I I I I I 1 1 I I` 50'WELL RADIUS \ ,..,---•
0 r0
SURVEY NOTE \ !I 'I \ O s na Li) E
// \\ \ BPSa' ,- a
THE BOUNDARY INFORMATION DEPICTED HEREIN WAS OBTAINED :-// / �� \ WIDTN p
FROM THE OWNER AND THE PIERCE COUNTY GIS SYSTEM. TEAM / \• ,
HUGHES ENGINEERING ASSUMES NO LIABILITY TO THE //---
, r"
ACCURACY OF THE BOUNDARY INFORMATION. / ''/,. I // \\ ��. \1
WATER LINE NOTE I/ N.
// WELL \y'I4 t `l` I'1� 11 �' ,� ce
w
GENERAL LOCATION OF WATERLINE SHOWN. EXACT PLACEMENT I \ I I BNV SBS �II IIIf �I I p� 4s227
OF WATERLINE COULD NOT BE VERIFIED AS THE WATER LINE WAS I ;I I :4 ` II, I ,,n�/sr E�,-
COVERED PRIOR TO THE FINAL SEPTIC INSPECTION. 10'MINIMUM I \ ;'� !�\ 4 BEDROOM
I S/OVAL F
SEPARATION FROM WATERLINE TO SEPTIC LINE HAS BEEN MET. NOME I
1 I \� /`` Date: November 24,2025
/
1 \
-\� / "I certify this design
\ / meets at rules and
\ I — I\ regulations of
\ \' / Washington State
\ I / Department of Health
VICINITY MAP \\ t I `_-- / andHealth Mason Deounty
N.T.S. 1, / 0' / p„
�\ sl.r.. EX BRIDGE /\\ \ //
N. / �/ O
'Lw //
/....:'''
I 2 S S
K K K
1 ��I lllli Y Y Y
•, oCN.NE•LY'N PRAIRIE 1 �` \ Ir. m
�/IIII I\ — 2
LI
�- I
I J APPROVAL BLOCK' .•:,•_
»•.. 1 1 1 1 1 1 1 1 •
.1 V/ Ea, r,,.\,1 ., 0 i t., -'..1 '' 0
CU
�ti�\�oN�0 < 2026 x
� p121 QQ cx Cl..
E
� o\* ,�, tiNsoN ooU��,�ENv�Ro jeliN c N
0 o _
N N O
_ N re g W
U
' N
E W
a m
/ \ 50 CUL-DE-SAC n q'I N
EASEMENT r� _
L'
\ Cr)_ m m
ro C
ro C O
U N
m
Q
THIS SYSTEM WAS NOT DESIGNED TO SUPPORT A SCALE: 1"=50'
.. GARBAGE DISPOSAL. I Job I/: 212158
4) 0 25 50 100
40
7 / Sheet: 1 of 2
N
N.
N. \ / E
U
t
\ CO N
400.00' T T N N
11I 7 L
I \ Yy..l R/�I tf) Ol
I ILw ..
a
7 O xc%
\ a,
--
\ " \ _
z °'
Y
8 2
/ \ SEPTIC COMPONENTS
\ / I I I I I I I I I \ \ \ \ \ / /,'•\
� `
\ \ ) -
0
HOME SEPTIC STUBOUT w
[•7 N O SEPTIC TANK LT;
WETLAND i �� p 1 Q
BOUNDARY N>i/ ------ ----/ \ 100'WELL RADIUS \ \ ` o r g PUMP T FE ANK
73 v, m a
\ r
`•� m O O SEPTIC SUPPLY LINE o ≥.
// // -\\/ 3 N. 7 • ? vo
/ / \\\\ 2 • = O SEPTIC RETURN LINE ••Y
STREAM / \\\\\ O� \\ 6 O PRIMARYDRAINFIELD �¢ 7j =
CENTERLINE \\ O� cc
Lu
/ /\ \ 1 1 \ \\\ / 50'WELL RADIUS i \ \ MONITORING/CLEANOUT PORT(TYP.) -o,
T�Fo 52ISTE p4 \
// � � \ :\ 5 �.-- 17.0' -sc. c�{'
I / \ \ BpSPI- $\ DRAIN FIELD RESERVE AREA
/ / 4
\\ •
\\ \ •.�.• w\pTH Date: November 24,2025
\ �/ // •\ •.•i' / meets all rules and
/ \ "I certify this design
\ // �\• % regulations of
/ X10 \ .,_., \ Washington State
/ / \ Department of Health
/
\ / \ t and Mason County
\ /// / 1` /III ``� \ Health Dep."
I - / WELL � I
\ 7 F \ I BNV
865
\
\ /\1 ��1I 4 BEDROOM
I j\\ �i HOME I y o
/
\ -- \\
/
\ \ --- -
\ \ _ \
\ _ ' �\ '� ��' / m
SCALE: 1"=30' A
\� / �/'` ��� / , o o o
\� / 0 15 30 60
rn
EX.;DRIVEWAY / / f o CO 5\. .
/ \ / / mega,
N
EX.BRIDGE \ / APPROVAL BLOCK y v TD
\y ' -�/•-,-- / ---- - - - - - - - - - , JAN 27
U
/ \ 2026 HEALTH °'
/, / M,SJN COUNTY ENVIRONMENTAL W
/ \ �� }+
E
/ '
pJ N
k / W E m
.46
'^ c
/ \ i ¢
Job 21-58
1 _ �l l l l I,
/' 1 / �\ ' 7 \ Sheet: 2 of 2