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Home My WebLink AboutSWG2024-00445 - SWG As-Built - 4/29/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 24-00445 Parcel # 220075100048 Applicant Name DEAN GOLDY Subdivision (Name/Div/Block/Lot) Applicant Address 71 E Dalkeith Rd TIMBERLAKES#8 TR 48 City, State, Zip SHELTON, WA 98584 Installer Name JAKE GOLDY Site Address 31 E DABOB, SHELTON Designer Name ADAM HUNTER INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type SIMPLE PRESSURE BEDS Pretreatment Type N/A >5 ft.from foundation? - --- ---- -- - - - - ❑ N/A AYES ❑ NO >50ft.fromwells? -- -- - - --- - - - �� -1� -- 0 ❑ ❑ >50ft.fromsurfacewater? - - - - - - - - - - - 1 - III ❑ ❑ Cleanout between building and tank? - - - .- -- - - -- ❑ ® ❑ CJ Tank baffles present? -- - - - - - - - - - - - - - - - - - -- ❑ ® ❑ 24"access risers over each compartment? - - - -- - - - ❑ ® ❑ Cl)W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - •- ❑ ❑� ❑ Septic tank capacity(working) 1284 gal Manufacturer HOUSE BROTHERS D-box water level and speed levelers used? ---- - - - - - - - - -- - 0 N/A ❑ YES ❑ NO 0O Manifold/D-box accessible from surface?-- - - - - - - - - - - - - - - - III ❑ ❑ GQCheck valves installed? - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ ® ❑ M Transport Line Size 2" Schedule/Class SCH40 Bedrooms installed (check one) ❑ 2 LU 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - - - - - - - - - - - - - - - - - -- ❑ N/A ® YES ❑ NO >100ft.fromwells?-- - - - - - - - - - ---- - -,` , -- 0 ❑ ❑ W >100 ft from surtace water. - - - -.-, LL >10 ft.from potable water lines?-- - ç-'- - -- - '; - _ _f_ _ ❑ ® ❑ > 5 ft.from property lines and easements?- � - - - yet ?PLHEP ❑ ® ❑ >30 ft.from downgradient curtain/found i�5�s - - - - - - - - - ❑ ❑ ❑ Drainfield level and observation ports sent --- - - - - - - - - -- ❑ 0 ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - -- ❑ 0 ❑ Pump tank setbacks consistent with septic tank?----- - - ----- - ❑ N/A LU YES ❑ NO `-� Pump tank capacity(flood) 1284 gal Manufacturer HOUSE BROTHERS < 24"access riser(s)and accessible from surface?-- - -- -- - - - - -- ❑ 0 ❑ ~ ❑ D ❑ Alarm or Control Panel Installed? - - - - - -- -- - - - - - - - -- - - - Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - ❑ 0 ❑ a ;Pump installed in ® Bucket or ❑ On Block or ❑ Other 9 'Pump Make/Model ZOELLER N152 ❑■ Floats or ❑ Transducer 0=. Tank draw down 2.625 in/min Pump capacity 65 gpm Squirt Height 6 ft Pump on time 0.92 MIN Pump off time 4HRS Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 220075100048 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -- - - - -- - - -- - - -- ❑ YES 0 NO If yes, please describe: N/A 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,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. {° APR 282028 = "' MASON COUNTY ENVIRONMENTAL HEALTH jN El 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 fun` r certify that all information contained on this I further certify that all information contained on this fo a d ace cord Drawing is accurate. form and attached Record Drawing is accurate. rs 4/24/26 Sign fur of Installer Date JAKE GOLDY Printed Name of Signee ,._ 04124/26 MASON COUNTY PUBLIC HEALTH '=�` The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health:, ADAfd J.fIUSTER rcrr,s linos Signature f En mental 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 RECORD DRAWING (continued) 1 . SCALE-1"=20'-0" SEPTIC TANK STU O /CLEANOUT O O PUMP CHA BER ORCEMAIN Q� BDRM RE VAL BOX DRIVE • l \ INSP.PORTS!LAT.CLEANOUTS y. W \\ MASON COUNw Eti'�liG�r�i�`IENTALH�AI-1�1 / 30' 10' 900FT2 DRIP WA \ 03/.12 26 Izj \ — nor,J s PRESSURE TEST COMPLETED BY INSTALLER SQUIRT HT: DRAWDOWN: JIM HUNTER & ASSOC. CONTRACTOR P.O. BOX 162, OLY,WA 98507 GOLDY EXCAVATION 753-1226 TIMER SETTINGS- JHANDASSOCIATES@HOTMAILCOM INSTALL DATE- 2/28/26 ON: RECORD DRAWING SITE ADDRESS/LEGAL OFF:• 31 E DABOB RD OWNER- DEAN GOLDY FINAL DATE- 3/12/26 TP# 220075100048 SITE#