HomeMy WebLinkAboutSWG2022-00436 - SWG As-Built - 3/18/2026 .
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00436 Parcel#319074490043
Applicant Name Smith, Earl Subdivision (Name/Div/Block/Lot)
Applicant Address PO BOX 1876
City, State, Zip Shelton, WA 98584 Installer Name Hanson Excavation LLC
Site Address 1003 W Kamilche Ln Designer Name Ad Htrr er `.50..M(5 (-Itr1(
• ..INSTAL.LATf.ON CHEC.KLiST .
►/ Full System Installation ❑Tank(s)Only El Dralnfleld Only ❑Repair ❑Other
System Type ?Mtge fo .4nJ(Med bed Pretreatment Type
>5 ft.from foundation? - - ❑ N/A EYES El NO
>50 ft from wells? - gE RAF-1E- El .7i ❑
>50 ft.from surface water? ----- - El 4 0
H Cleanout between building and tank? -MAR-1-s.20E- - - ❑ 0
o Tank baffles present? - - ❑ 4 0
24"access risers over each compart El,?-- - El X ❑
0W Effluent filter Installed?- ,. ElX El
Septic tank size 1500 gal Manufacturer Haggerman Preacast
o I:! El D-box water level and speed levelers used? - X N/A ❑YES o NO
O ' Manlfold/D-box accessible from surface?- - � 0
o Oz Check valves installed? - 0 El
a Transport Line Size 2" Schedule/Class Sch.40
Bedrooms Installed(check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 1I Commercial/Other
>10 ft.from foundation?- - ❑ NIA 1 YES l No
o >100 ft.from wells?- - El 1, ❑
W >100 ft. from surface water? - - ❑ 0
4.
LT, >10 ft.from potable water lines?- - 0 kl.1 0
> 5 ft.from property Ilnes and easements?- - El ® El
>30 ft.from downgradlent curtain/foundatIon drains? El es 0
®. Dralnfleld level and observation ports present - - El X 0
® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover Installed over dralnfleld?- - El ® ❑
Pump tank setbacks consistent with septic tank? - • ❑ N/A El YES ❑ NO
Pump tank size 1500 gal Manufacturer Haggerman Preacast
d24"access rlser(s) and accessible from surface?- - ❑ X El •
~
p., Alarm or Control Panel Installed? - - 0 ® CI
E Control Panel equipped with Timer/ETM/Counter- - ❑ ® ❑
12- Pump Installed In Eg Bucket or ❑ On Block or El Other
6 .Pump Make/Model liberty LE41 M El Floats or ❑ Transducer
a Tank draw down 3 in/min Pump capacity i 6 gpm Squirt Height 3 ft
Pump on time 1.5min Pump off time '6hrs Dally flow set at Lec2O _gpd
Updated 812112018
. Mason County OSS Installation Report pg, 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - O YES ER NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - O YES O NO
RECORD DRAWING
'
Title Is a permanent record and must bo accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record
Drawings contain: Dralnfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve dralnfieid,existing and proposed buildings,location of wells,waterlines,
wells,observation ports,cleenouts,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 contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record i g is c r .
— G%�LddrL 3/10/26
Si ature of Installer Date
•
I -1.....c.Jared Hanson l: : '
` E
Printed Name of Signee fi .
MASON COUNTY PUBLIC HEALTHklipp,," La` 4:¢,t - ��.)-}
The undersigned approves this Installation Report nt/Ct y O�`•' 51tru.73 F "f
Record Drawing on behalf of Mason County I jR WO
Z, IAMLS R.ttl_, 1-R .
ir/,� � LICENSED DESIGNER
Healt •
MgSONSo�NTY ,8 2(n6 mc=4�.ES: 2ln�c.
3 (( ( z ENV/Rn,
Signature of Environmental Health Specialist DaiQJ,.1 rfE"JA(yEAtrN (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 81211201e .
RECORD DRAWING (continued)
•
Same as design with exception of Primary and Reserve locations being swapped
•
MAR 18 2026
MASONOO JN�ENVjR0
DJA NMEN'AL HEALTH
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