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Home My WebLink AboutSWG2025-00219 - SWG As-Built - 5/18/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH Permit Number SWG 2025-00219 Parcel# 32002-43-90010 Applicant Name Elizabeth Seabright Subdivision (Name/Div/Block/Lot) Applicant Address 201 SE Weston Rd LOT 1 SP#3172 AF#2218223 S 41129 City, State, Zip Shelton,WA 98584 Installer Name County Line Development, LLC Site Address 360 E Bayview Dr, Shelton Designer Name Arrow Septic Designs, Inc IN5'C�4L `�I }i CHECKLIST, ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type OSCAR XO2 treatment Type OSCAR XO2 • >5 ft.from foundation? -- ---- - - ❑ NIA *YES ❑ No >50ft.fromwells? -- -- - - - - - - - - Q _ � ❑ 0 ❑ >50ft.fromsurfacewater? -- - -- - ❑ 0 ❑ Cleanout between building and tank? -\-. - .'- - -->. ❑ ❑ - -• Tartkbaffiespresent? - - - -- - --------- O-- ❑ ❑ H ;24" access risers over each compartmen . , - - --- - - -- - ❑ ❑ 'W Effluentfilterinstalled?-- - - - - - ------ -- --- - -- - - - - - CI,' ❑ ❑ Evergreen Precast Septic tank capacity(working) 1,000 gal Manufacturer D-box water level and speed levelers used? -- ---- -- ----- -- ❑ N/A ❑ YES Q No Manifold/D-box accessible from surface?--- - - - ----- - - -- - - Check valvesinstalled? - - -- - - - - ---- - - - - - --- ---- -- ❑ ❑ L]•B', Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other • >10ft.fromfoundation?-- - - -- - ---- - -- - - - -- - ---- - - ❑ NIA DYES ❑ NO >100ft.fromwells?------ -- --------- ------------ ❑ Q ❑ —, >100ft. fromsurfacewater?- - - -- - - - -- -- - -- --- -- -- - - ❑ 1i ❑ ltd ; °ta >10ft.frompotablewaterIines?- -- - ------- --- - - - - - - - - ❑ ❑ z ' > 5ft.frompropertylinesand easements?--- - - - - - - - --- - - - ❑ 0 ❑ • > 30 ft.from downg radiant curtain/foundation drains?-- - - - - -- - - ❑ ❑ „ Drainfield level and observation ports present - - - - - - - - - ----- ❑ ® ❑ • Propercoverinstalledoverdrainfield?--- - - -- ----- ----- - - ❑ W ❑ • Pump tank setbacks consistent with septic tank?-- ---- - --- - -- ❑ N/A Q YES ❑ No Pump tank capacity (flood) 1,000 gal Manufacturer Evergreen Precast < 24 access riser(s)and accessible from surface?------------- ❑ ❑ AlarmorControlPanelInstalled? - - ---- - - - - --- - - -- - --- ❑ ® ❑ k E Control Panel equipped with Timer!ETM/Counter - - - - - - - - -- ❑ ® ❑ Pump installed in ❑ Bucket or ❑ On Block or ® Other on bottom of tank Pump Make/Model AY McDonald E-30, 1/2hp, 115v ❑ Floats or ❑ Transducer Tank draw down -- in/mm Pump capacity 30 gpm Squirt Height -- ft Pump on time 30 seconds Pump off time 3 minutes Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg.2 parcel#_3 3 Zoo2.- 4 -`Ioo 1O -- ABANDONMENT RECORD. . . . . . Were existing septic components abandoned as part of this project? --------r ------ [3 YES NO If yes,please descibe: _ 0 YES ONO Were all components pumped out and properly abandoned per WAC246-272A 03fl0? ------ RE ORES DRA i !, .t .':�.', '•. . •' actryid*s and fedora davalaA 8PL Typl�itacord • reeood and must ba acasr4e and desciPtiva enough to re4°eate In she nee ropcsd be ings.Eocation of we1Lswatecimes, This a pernsam�+t tanklocation.Noahsnow,nstin9 Pwets. ordain: pfd&manandd wienMa n d 1By delays m final installe�n approve acid related� 'oasts. Pte.deer wmt and other nsllten� awes per•lncornpleie Record 1 1LcIkL Record Drawing Attached : .. OERf.10#T1ON'OF iNST1i, .AT10 ': ' . 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 cieared/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 1 fu a that all information contained on this I further certify that all information contained on this fo attached Record Drawing is accurate. form and attached Record Drawing is accurate. \ i s zj Signature of installer Date a MICHAEL LOVELY l9 IZ®/2o Printed Name of Signee �y a�.ay �� c 1 MASON COUNTY PUBLIC HEALTH ll �,} The undersigned approves this installation Report and rr,r' s10o3as P PAULA JOY JOHNSON F}� Record Drawing on behalf of Mason County Public L't'�ItSctj� 5jtot�l"tf2" + Health: EXPIRES 91 ( f24 SignatureS-TD Signature ofrivironmeflt Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE tjpdalut 812112018 •� a�'�•+' '.-+ pi`s. �> 9G 4° APPROVED MAY 16 2026• ® --- MASON COUNTY ENVIRONMENTAL HEALTH RET 5100349 PAULA JOY JOHNSON-a;'• � : d EXPIRES 1 / i • Visual Alarm- Control Panel with Audio — � 1 O Cleanout © 1,000 Gallon Septic/Aeration Tank• ` 2-Compartmeat with air diffuser 1,000 Gallon Clarifier/PumP Tank• 2 Compat Headworks T�J O OSCAR XO2 Mound Drainfield i . ay ' r ` KaYla Milam Froth• --- - - - - _ To- Wednesday,April 29,2026 6:11 AM Subject: Environmental health OSS Inspection request for michael lovely-swg2025-00219 Submittal request for: michael lovely Site Address:360 bayview Permit Number:swg2025-00219' Parcel Number:320024390010 Jill)[ p L� Installer Name: michael lovely [Jill APR 2 .9 2026. Installer Phone Number:3602920909 By Installer Email Address: MIKE@COUNTYLINEDEVELOPMENTLLC.COM Designer Name: paula johnson Designer Email Address:paulaj@hctc.com Inspection Request Date:2026-04-29 Inspection Type: Full System Comment\Notes: Thank you for submitting your final install request.The install should be complete and ready to;inspect-on the'Inspectiori, Request Date'and remain uncovered for three business daysto,allow staff time to inspect. Poor weather situations may be accommodated by contacting.onsite staff. Installer is responsible for obtaining Septic Designer/Erigineer installation approval prior to backfill of system components. If no:contact is made by the health department within,the three business days of notice,the installer.may cover. Mason County Asbuilt Form, Record'Drawing,and Installation fee must be submitted for final installation.approval. r y Ra I .y' 1 JL l itr • s-•T7s�'r y, ,�,,,,,,,.�<« �. fi P., � k _'� l Yp �..Jj�.,,T 'i, .z`�'+p,^h+iw.�✓'S�'�tx'��f' �.. • • 1 • ' �R'+t; N !S�!3 S '�-i `_p iY ) ^� � V� Rt ;'. at -'l � ,.h1h aM1 wrh r # i4r. i9 � x a ry � 'a u I'sR/� .r�� i��f1 lk�/r�: :.✓ i iy:;i .� t<7.�r� t.'� _�, > �% � yrJS�ip� " tit y riL �k 1Zr1�8 r 1� d sr c•'+�S A),�� Y ++ q l Y�'tjl�{'I�V�s� f� /l ,...4r„ i n ; S y, �'��tk��l�� .',c�,v��X��{'s�l..ti(�,�,ii��Sx;+d'tr4t. �`'''',�.�k� `3«�„, �'� ,, •t, _.� �I.