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Home My WebLink AboutSWG2025-00070 - SWG As-Built - 2/23/2026 Mason County OSS Installation Report pg. I MASON COUNTY PUBLIC HEALTH ,. APPLICANT/ PERMIT INFORMATION Permit Number SWG 26.26--- 0-7e) Parcel# 32006-50-02073 Applicant Name TRAVIS/DAWN TWIDDY Subdivision (Name/Div/Block/Lot) Applicant Address 121 N ENATAI CT ICOM7,73 City, State, Zip SHELTON,WA. 98584 Installer Name . b I L...„ ` v „ ,.. Site Address 1910 E I SIM) La- _ p0 Designer Name CT prra INSTALLATION CHECKLIST 'y+'-: O Full System Installation EtTank(s)Only ❑ Drainfield Only 4 Repair O Other System Type C tt-a,,r a Pretreatment Type a U i''s.. cP9d >5 ft.from foundation? - - O N/A 0 YES ® NO >50 ft from wells? - O d IN ..; >50 ft.from surface water? - ::--ac: Cleanout between building and tank? - - ❑ O O ,:c j,. Tank baffles present? - - O O O C . 24"access risers over each compartment?- .:;idJ Effluent filter installed?- O O 0 Septic tank capacity(working) /3 V Z CPC U. gal Manufacturer ,_r.AZ, /f-n.A.L. 0 D-box water level and speed levelers used? - - ❑ N/A ® YES ID NO -XO Manifold/D-box accessible from surface?- - O O O ;c u., m2'- Check valves installed? - - O O ❑ GeF.. •2'. Transport Line Size Schedule/Class Bedrooms installed(check one) 0 2 O 3 ®4 ® 5 ❑6 ®Commercial/Other >10 ft.from foundation?- - ❑ N/A El YES ® NO In >100 ft.from wells?- - O O 1k >100 ft. from surface water? - U. >10 ft.from potable water lines?- - ❑ ID El Z' >5 ft.from property lines and easements?- - >30 ft. from downgradient curtain/foundation drains?-. - III O O ®,, Drainfield level and observation ports present - ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ I31 O Pump tank setbacks consistent with septic tank?- - O N/A ® YES El NO Pump tank capacity(flood) gal Manufacturer 24"access riser(s)and accessible from surface?- - O O O F' Alarm or Control Panel Installed? - - ❑ O O a Control Panel equipped with Timer/ETM/Counter - O O O TEL, Pump installed in O Bucket or ® On Block or O Other • m. Pump Make/Model � O Floats or O Transducer ,,,R, Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time o B Daily flow set at gpd Vr-,?,"fie eerPz( 0Ars3.O Pa 81$112018 ' Mt on C•'unty OSS Installation Report pg. 2 Parcel# 32006-50-02073 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES ! NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - O YES O 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. _/ 4' -tr 14 r z IL) kr-- P-13,A _eiwiie ® clew--PC-- tT ec 8-6' c1 .G'( ',/Z-,4-1 +ite. i O0 eferGicak P ;P•Pele401e A P e-A-4,4e0 iij 0 L1vl,r4,,vi `�ieiOerTv9 e 'M i ! 474.2 by o CD Cast-.7 C,c.r1^/I/�� D 'b" �,.1 ..P<*" cd Qak 0 r1 (Lard EL//2da2 Th 1M -166a CctIArai S fr(i471611' ) r-f-L{. A, Y- ® Record Drawing Attached .. . . _ CERTIFICATI N OF INSTALLATION L 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 R cord Drawing is accurate. form and attached Record Drawing is accurate. �?-«-z 4 1 �, r natit re of Installer Date �� 1 f 44 fri Printed Name of Signee �,geF s�'i•'• -.2; 1, ate { t'' �, a MASON COUNTY PUBLIC HEALTH .& •"4 - -�s� ,•cp ,,`,2t, .c' 100 8 ,o ai 51-I'" The undersigned approves this Installation Report and o� CINDY E.WAITE �% Record Drawing on behalf of Mason County Public LICENSED DESIGNEE �� Health: EXPIRES 05/101 t9n' t/1/\1) LIM *3)16 Signature of Environmental 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!21/2'' Mason County OSS Installation Report pg. 2 Parcel# 32006-50-02073 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES ❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ 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. (PIO 1 0 l ' R fs® d !, i Al ,r t / added fl Jd.t, l I C Osv2 i C- P- 9 let c- D " 4,c . us-,,,,I e',,,i r L..? C.A.... '-{Z.,4,01' -14". A Na1�8, ®' ecw144 ' Fe °t�(1 o sfi 05 p49e 1/4O(Ls. i-vt ®f s•4,45 Z®, a-f. inew WO p.er4 'ket. 6 e'!@9 fret 4 AtAr.s. ., Ca_. cjita c7d60 ❑ 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 R cor awing is accurate. form and attached Record Drawing is accurate.na re of Installer (es- Date ";f Printed Name of Signee t, i. - > MASON COUNTY PUBLIC HEALTH y: 51 es 0t �m The undersigned approves this Installation Report and •: o� ciao WAITE••- . . Record Drawing on behalf of Mason County Public ucervst DEsICNER Health: ElxPikLS 05,10/ '20 0 07250 I Signature of Environme tal 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 : \ APPROVED OVER FEB 2 3 2026 'V I \ \ . MASON COUNTY ENVIRONMENTAL HEALTH se - J RED / -. 1. Resid \ \ 2. Existing Septic tank - drainfield 3. Existing j r 4. Carport / \ \ - Ve \lc storage(n°t on a foundation) /- orary ° A \ O 5. Temp � o A�6 ..-. _- _ _'� area C�ic' - ) k .-�, g. Proposed reserve /// . A.,: . --- 17, ` 7. Existing well / ' ' ' Neighbors well / / g. Neig �/ < ` of g A3 ig Goo �� \\ / /' \ \ �` �I' \ / / : •%.. _-.t o aye r a} C O ev)\ ilie .,' .......... P \ / \ /// \ \ :,;:.'dry,,_ , / \\\. . , \ . \•gym S-�•'%: •;�� I /� / . 4, , : . : , , \\ ...-tt11 I , \ ____.,. .,, ,, ,, - ___, .0— I I . ' , \ .,,i/ __---1 .., - I 1 ...... � �'-�: \ t �_ ',Grp.�' � . = , ,,„ ,, \ \ `' A P VED _ . , -1% ' '-',. II ' 1• 1 1 114 'I :` \ --� AOP�COUN�' NiRON , N�A�0�'� x .2®06_ 3-0, 62 073 ' C-1-9' \ \ 401.6. \ d \ 1 \ ,../ - " _ • .1- (04, „if \ O� E:SIGNER W S I•' qi V 1 /) IL \ \ \ ' LICENSED `1 ` C_, 2.0_2 ,,,, I\ \ �x HESUs a �� 1 I'— (1`ms`s / \ 3l