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Home My WebLink AboutSWG2026-00090 TANK ONLY - SWG As-Built - 3/31/2026 Docusign Envelope ID:967B14AA-EC44-4309-A773-3E74F7A2E499 4 ik Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG W - C')D0 6' Q Parcel# 32021-52-01030 Applicant Name QUARANTA, MICHAEL VITO Subdivision (Name/Div/Block/Lot) Applicant Address 400 SE Mell Rd SHORECREST ADD BLK: 1 LOT: 30 &T.L. City, State, Zip Shelton WA 98584 Installer Name Jamie Workman Site Address 411 E ORCHARD LN Designer Name Micah Halverson INSTALLATION CHECKLIST ❑ Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Existing Gravity Pretreatment Type Septic Tank >5 ft.from foundation? - -- - - - -- - E N/A ■ YES NO >50ft.fromwells? -- - - - - - - - - - - - - i ❑ ❑■ ❑ • Y >50 ft.from surface water? -- - - - - - - - D LII Cleanoutbetweenbuildingandtank? --- -lL - - -- - - - - - - -- - ❑ 1• ❑ V Tank baffles present? - - - - - - - - - - - -- - - - - - - - - - - - - - - ❑ ❑■ ❑ a24" access risers over each compartment?-' - - - - - ❑ III ❑ LU Efuentfilterinstalled?- - - - - - - - - - - - - - - - - - - - - -- - - - - ❑ ❑■ ❑ Septic tank capacity (working) 1278 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - - - - - - - - - - - -- - ❑ N/A ❑ YES ❑ NO 0O Manifold/D-box accessible from surface? - - - - - - - - -I-/-A - - - - ❑ ❑ ❑ G0z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑ GQ Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?-- - - - - --- - - - - - - - - - - - - - - -- - - ❑ N/A DYES ❑ NO >100ft.fromwells?--- - - - - -- - - - - - - - - - - - - - - - - -- - - ❑ ❑ ❑ W >100ft.fromsurfacewater? - - - - - - -- - - - - - - - - - - - - - - - - O ❑ ❑ u. >10ft.frompotablewaterlines?- - - - - - - - - - - - - - -N/'4 ❑ ❑ ❑ z > 5ft.frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ ❑ ❑ > 30 ft.from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - - - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? -- - - - - -- - -- -- ❑ N/A ❑ YES ❑ NO `hd Pump tank capacity (flood) gal Manufacturer Q FZ- 24"access riser(s)and accessible from surface?-- - - - - - -- - - - - ❑ ❑ ❑ 0< Alarm or Control Panel Installed? - - - - - - - - - - - - - -N/A- - - - ❑ ❑ ❑ Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a _ Pump Make/Model ❑ Floats or ❑ Transducer Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Docusign Envelope ID:967B14AA-EC44-43C9-A773-3E74F7A2E499 Mason County OSS Installation Report pg. 2 Parcel# 32021-52-01030 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -- -- - --- - --- - - - 0 YES NO If yes, please describe:Abandoned existing 750ga1 septic tank Were all components pumped out and properly abandoned per WAC246-272A-0300? - --- - - -- l■ 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 parts,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Initial owners Initials: I v 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 r , hed Record Drawing is accurate. form and attached Record Drawing is accurate. 3/26/2026 Signature of Installer Date \y Jamie Workman Printed Name of Signee MASON COUNTY PUBLIC HEALTH g The undersi ned a roves this Installation 9 Report and' pp p Record Drawing on behalf of Mason County Public Si0Q Health: it DESOM f1 2 rE"FIREs: 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 8/21/2018 Dicusign Envelope ID:967B14AA-EC44-43C9-A773-3E74F7A2E499 SEPTIC TANK REPLACE /!ENT ASBUILT m X i=_Lv6 Shorecrest Drive o I— Property lines Established By Other J O m M p O_ O Q t z ELV5 Cl) J Iot•2S W t ❑ Lot:311 V O � Approximate Land Size: 1.96Ac cV A ot•26RZ V C V O APR 0 ' o o w MA ON COON F 20 6 a R t ncA � o ET ' Existing — — — 1 Bed Structure xiuctu Cn -- � tructures _ _ — O Orchard Lane / / V" � 3j \ Main -� — - - ¢ c000 N i Home O rn / ELv3o \ 2 2 Bed Q \ 1 __� - 4 Driveway. \ ` U) J R=50' 50 Water Meter; W 5horecrest Water Weil bExisting Structure 'M \ ELV20 / O ,ALLOUTS 1)4"ASTM 3034 with Cleanout \ 5 2) IM-1250 2 Compartment Infiltrator Tank 3) Existing Sewer Transport line from Bunk House Owner/ / 4) Existing Effluent Transport line Applicant: _ 5) Existing D-box/Drainfield Bulkhead 6) Existing Sewage Pump Tank ELV10 * Existing Alarm installed on Structure O d- E 7) Existing Waterline to Main Home -j 00 0 �_� 8) Existing Yard Hydrant and Waterline from Well 00 Y *Well Water to Bunk House rn o o 0 a U ,rMMSLEY INLET This is not a surveu: 300'+I This Asbuilt Drawing is intended for the purpose of > X CO locating and maintaining the septic system on this parcel. :� �!g cc Co > Measurements and distances are approximate. It is advised by septic designer Micah Halverson I 51ap1pB to use a licensed surveyor to determine lot lines, Initial /Initial j�,,�y� {► iW1LV8W0N s0' 0' 1 s' 3s' 60' a = elevations,topography and to provide a legal site plan. I LI(�tBED DEStQI!IER I I I Owner is responsible for establishing all property lines, I easements and/or right-of-ways. Scale.130-30 Inspection Date 3/23!2026