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Home My WebLink AboutSWG2025-00262 - SWG As-Built - 1/30/2026 It Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG2025-00262 Parcel # 320267590171 Applicant Name TINAJERO,GERARDO ROMERO Subdivision (Name/Div/Block/Lot) Applicant Address 11 W BOLLING RD, City, State, Zip SHELTON,WA 98584 Installer Name Franklin Clark-A +Onsite, LLC Site Address 580 SE Yarrow Ln,Shelton,WA 98584 Designer Name Franklin Clark- A + Onsite, LLC INSTALLATION CHECKLIST in Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Gravity Pretreatment Type N/A >5 ft. from foundation? - r-,-== ❑ N/A II YES ❑ NO >50 ft. from wells? ri V LL',.` iii-'- ❑ ❑ Y �r i.y Z >50 ft. from surface water? - ❑ ❑ 1-- Cleanout between building and tank? - -I 1_ -A41-4a(--) 2026- -1 - El MI 1110 Tank baffles present? - - ❑ ❑ a24" access risers over each compartmeritu y __0 - ❑ M ❑ W Effluent filter installed?- - ❑ ❑ li Septic tank size 1200 gal Manufacturer Hagerman's Precast O D-box water level and speed levelers used? - - ❑ N/A Ill YES ❑ NO 011 O Manifold/D-box accessible from surface?- - ❑ Il ❑ o0Z Check valves installed? - - IN ❑ ❑ oQ 2 Transport Line Size 4-inch Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 3 ❑ 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A It YES ❑ NO O >100 ft. from wells? - - ❑ II ❑ W >100 ft. from surface water? - ❑ IN ❑ L.T. >10 ft. from potable water lines?- - ❑ MI ❑ Z > 5 ft. from property lines and easements?- - ❑ II ❑ a ce > 30 ft. from downgradient curtain/foundation drains? - - ❑ E ❑ Drainfield level and observation ports present - - ❑ Il ❑ ii Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ II ❑ Pump tank setbacks consistant with septic tank? - - . N/A ❑ YES ❑ NO • Pump tank size gal Manufacturer No Pump Tank- Straight Gravity System Z < 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ a. Alarm or Control Panel Installed? - - ❑ ❑ ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑ ❑ D a Pump installed in ElBucket or ElOn Block or ❑ Other _ a Pump Make/Model ❑ Floats or � ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd + Updated 8/2112018 , N. Mason County OSS Installation Report pg. 2 Parcel# 320267590171 ABANDONMENT RECORD Were any existing septic components abadoned as part of this project? - - O YES . NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - O YES ll 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. 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 1 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. Q-AatiaL,,k, 01/29/2026 Signature of Installe Date Franklin Clark-A+Onsite, LLC Printed Name of Signee MASON COUNTY PUBLIC HEALTH jrl /I The undersigned approves this Installation Report a ,4 ; FRIA(1 °J `°1'+, Record Drawing on behalf of Mason County Public Health: 7/4So A-4 01/29/2026 jC ly 7(2 (Zo' Yeiv, O2 Signature of Environmental Health Specialist Date£ /4°N/yf l,�q (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIU, EW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 Redline Drawing , SCALE: 0 15 30 )c ,),o,),6 S 101 Designer's Stamp 1rXN , CI Phone Box O O VA OO ^h ho n0j o to r—..-120 ..—..—..—..—..—..—.--..— —..—.- 125 —.. . —.0 0 19'iF �30 ST./. •.4135 9N• rD � - - - Proposed Power Line - . Shed: °/ fey ' 'f' 716'+1-I -.. 4 ••Il O \ T f Q O / -/ , ra : �'X 50' =�;:F 5,000,3 W:fll 8 ti . flANKLIy4cu R•, r---- �, .... `�°�o• of Bui IooI ` ' <,,� o ori�ewaI 13Jan2026 Io ,5YN-�--- --- ---- ---- --- -� P- - - T �BDR - SFR i o of ' --- - --- .- --- --- - - - c. o o o 30 oa..s, ; o �� • SS d- County Review 0 0 0 .,.., ...„. - O,4 O ---' o ,•tea• -^a . " v r �` o o ,:to,�r �/ FEB oz o ,�' 026 o t iv o m MASON COu —< NTYENVIRONMENTgL HEALT ,Ci. D,lq H1 ow% O O I o 0 0 o I + � I o O 0 r 330'+/---•--- ----•--------.—..—.._..—..—. —..—..—..------------ .—..��.-------------_..—.. ------- ..-------..—.. I A+ Onsite, LLC 4 Commerical&Residential Septic Design P.O.BOX 1954,SILVERDALE WA 98383 TEL.360.830.4765 aplusonsite@live.com Name:TINAJERO,GERARDO ROMERO .. .. m PRESCRIPTIVE FLOW CONTROL MEASURES ATTENTION PROPERTY OWNER Address:580 SE Yarrow LN, ZL_LJ gi=i g F , o 6 F cc `? a PRESCRIPTIVE FLOW CONTROL MEASURES ARE TO BE DESIGNED E.Y LICENSED INIVIDUALS IAW APPLICABLE STATE AND CAREFULLY REVIEW ALL ASPECTS OF THIS SEPTIC DESIGN,ANY COSTS INCURRED DUE TO CHANGES TO THIS DESIGN Shelton,WA 98584 w w o r o ¢ w LOCAL CODES.THE DEPICTION OF THE I PTT ON THIS SEPTIC DESIGN IS FOR ILLUSTRATIVE AND PLANNING PURPOSES AFTER SUBMISSIONTOTHE LOCAL HEALTH JURISTICTION ANDTOTHE DEPARTMENT OF COMMUNITY DEVELOPEMENT J 5 g ,E $ g 8 w w 3 ' i F. ONLY AND SHALL NOT BE CONSTRUED AS A FINAL SOLUTION TO STORM WATER MANAGEMENT. ARE THE SOLE RESPONSIBILITY OF THE PROPERTY OWNER. g w W W o P/N:320267590171 m 3 w w s 3 a a LL ® THIS IS NOT A SURVEY METHODS AND EQUIPMENT ALL PROPERTY LINES AND BOUNDARIES DEPICTED HAVE BEEN DEMONSTRATED BY THE PROPERTY'S OWNER(S), THIS DESIGN'S SITE FEATURES,TOPOGRAPHY,ELEVATIONS AND BENCHMARKS ARE BASED ON THE FOLLOWING-THE Submission Date: CO x BUYER(S),THEIR AGENT(S)AND/OR LOCAL JURISDICTION LAND GIS DATA AND ARE INTENDED ONLY FOR THE REVIEW DESIGNER'S COLLECTED SITE DATA,ASSUMED DATUM PROVIDED BY THE PROPERTY'S OWNER(S),BUYER(S)OR THEIR O� O O O a O T I I AND CONSTRUCTION OF THE PROPOSED SEPTIC SYSTEM DESIGN.A+ONSETS,LLC RECOMMENDS THAT A LICENSED AGENETT(S),AND LOCAL JURISDICTION PLANNING AND LAND SERVICES GIS DATA AND ARE INTENDED ONLY FOR THE Rev: Submission Date: o III. T I I ' PROFESSIONAL LAND SURVEYOR BE USED TO SET PROPERTY CORNERS,AND/OR TO ESTABLISH LOT LINES AND REVIEW AND CONSTRUCTION OF THE PROPOSED SEPTIC SYSTEM DESIGN. VA''InAl wci' lf,i7"litc