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Home My WebLink AboutSWG2023-00326 - SWG As-Built - 3/6/2026 , Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00326 Parcel# 22003-50-00008 Applicant Name Exodus Acres LLC Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 76 City, State, Zip Allyn, WA 98524 Installer Name South Shore Construction Site Address 31 E Fox Ln, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION C - LIST • 0 Full System Installation ❑Tank(s) Only O,,i � \`\❑ Repair ❑Other " \ System Type Shallow , ,.a `{ Pretreatment Type >5 ft. from foundation? \ b- - - �'�� ❑ N/A 0 YES ❑ NO >50 ft.from wells? 1ti ��- - - -- - ❑ 0 ❑ >50 ft.from surface water? - - - - ❑ 0 ❑ H Cleanout between building and tank? - -- - - - ❑ 0 ❑ U Tank baffles present? - �� - ❑ 0 ❑ P. 24" access risers over each compartment?- - ❑ 0 ❑ D. W Effluent filter installed?- - ❑ 0 ❑ c Septic tank capacity (working) 1250 gal Manufacturer Infiltrator D-box water level and speed levelers used? - - ❑ N/A ❑ YES (] NO O Manifold/D-box accessible from surface?- - ❑ 0 ❑ O.:.II Check valves installed? - - - -e p- ,4- - ❑ 0 ❑ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - ❑ NIA 0 YES ❑ NO ` 0 >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - ❑ ■❑ ❑ E. >10 ft. from potable water lines?- f.., k -t_ ' i❑ k. _.. 0 ❑ > 5 ft. from property lines and easements?- - ,' `= O CF, i>.� 0 ❑ e -6— 7iTs r �r E! . > 30 ft.from downgradient curtain/foundation tat,?- — o: ❑ ��..�xi� 0 ❑ Drainfield level and observation ports present - FF ® ❑ 0 Graveless chambers or ❑ Clean gravel used?0(cNheckNone NMENT�HEALTN Pro per cover installed over drainfield?- coral - - ❑ 0 ❑ Pump tank setbacks consistent with s eptic tank?- - ❑ N/A 0 YES El NO Z . Pump tank capacity (flood) 1060 otgal Manufacturer Infiltrator c 24" access riser(s) and accessible from surface?- ❑ ® ❑ I-- Alarm or Control Panel Installed? - ❑ 0 ❑ ,*- Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ D- Pump installed in ❑ Bucket or 0 On Block or ❑ Other m• Pump Make/Model Liberty 280 0 Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 38 qpm Squirt Height 3.5 ft Pump on time 2.3 min Pump off time 6 hr Daily flow set at 360 gpd Updated Et/21/2018 , 1 • Mason County OSS Installation Report pg.2 Parcel# 22 003" 5 0 —0000P • • ABANDONMENT RECORD ` NO Were existing septic components abandoned as part of this project? - V O YES If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES O NO , RECORD DRAWING • ... . . This is a permanent record and must be accurate and descriptive enough to relocate In the need of maintenance activities and future development. Typical Record Drawings contain:Dratted&mmtit id Cdtntaial&layout,Septiatpump tank location.North arrow.reserve dm#nlleid.existing end proposed buildings.location of web,v4.iatfine5. wells,obzGvatiott peens,dprieuis,and other maintenance access points.Incomplete Record Drawings may create additional delays in final installation approval and related perdts. LE tB-e,�e-mss +° s teyel. (a) r-.0Q,_1. 2f-k ,Qvcwvv,. . .. ,,,..1 1 p R fill rg: „ . t,,. v fl El '•' 1 ' MAR 0 6 2u26 : It', MASON.CO.UNTY ENVIRONMENTAL, E LTH ` • , J WWW Record Drawing Attached rc <. :� .CERT]FICATIONiOF.INSTALLATION „. y. Y:` , :' `;t,,;::a; .',.`.J. ':.: INSTALLER DESIGNER/ENGINEER I certify that!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 f n atta ed R rowing is a curate. form and attached Record Drawing is accurate. • co-24-2.5- Signature of Installer Date t Printed Name of Signee , , ,o •W48, • • �r aka+_ ��• N MASON COUNTY PUBLIC HEALTH '% �u1 -.0s;�t. • The undersigned approves this Installation Report and %'. 5100349 V I Q.: PAULA JOY J0HNS0N..?"\\5 Record Drawing on behalf of Meson County Public4. Lie i�tul=;UESi _ i:k"" H-.,Jth: EEXXPIP•itt s o9/1s/,[^WWW UV 4Aj -a 3-6‹-Up Sig irmnmental Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated B21r2tt18 , , - frl, L N ---- . ferbo SC S Dnvcwa� 20` `o s5 30 45 (o0 N 5;. As-lot(i (t S' x Li 27` 33`x. 0 o e i o 4uS flicr€s LLLL 'l Mart uPotchArCd ° P� C,� L 2:2.003-50" 00008 I/O LAbhS;zed Pro►m H O m e- p s o ©' '31 a X L-N. R0 3 Og -71.��EC 6-0,a.s,1 20% .-- AN . a (5)3 X LID' 0/. ai . r►r'LrnY di-. o a a �'r("P.c./11"-A. - - u Q G. ,,,,.; h, N r 15' x 6_0' i :5'rn;�, /k...., rre s�rv� L.OSCAR ResetVe 1 O,.b ov e,. ............ r , .,., . _ \ A [S'pp� K gi'/) sli El�yy// py1Lin 1 -:@,:-4, MAR 6 2, ,� tti:11))5y�9yG'��f a 6SP,:�...� rASON COUNTY ENVIRONMENTAL HEALTH I 0 Audio-Visual Alarm • 3 Cleanout 4 STME t•-) 3 0(250Gallon Septic Tank �� Q A, �4 2-CompartTnent with C Iv ` 5� Effluent Filter. L ps N b V 5 E r. \ � O l,727 Gallon Pump Chamber _ F LooJL C.tp6O, C:..(5 5v LT( d' ( Valve Control Box m N .0'\A 01 Ash N.4 a' � ,:`1 • yJ+�. 5100)49 ?' sr PAULA J0Y•-J0HMS0N •� ,,l!'�� Cam lsOPI1lb .