HomeMy WebLinkAboutSWG2025-00297 - SWG As-Built - 5/18/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT IT µINFORMATION
_.
Permit Number SWG 2025-00297 Parcel# 32008-42-90054
Applicant Name Elaine Goodhart Subdivision (Name/Div/Block/Lot)
Applicant Address 40 SE Goodhart Way
City, State, Zip Shelton, WA 98584 Installer Name Arrow Excavating
Site Address 521 E Capital Prairie Rd, Shelton Designer Name Arrow Septic Designs
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair Q Other x,000 gal 2 comp @ future ADU
System Type Sand-lined pressure bed Pretreatment Type
>5 ft.from foundation? -- ---- - - - ❑ NIA Q YES ❑ NO
�d
>50ft.fromwells? - - - - - - - - -- - �r �- ❑ ❑
>50 ft.from surface water? -- - - - - - - 1�-
RE- ❑ UI ❑
�£ Cleanout between building and tank? - - ---- --- - ❑ ❑
Tankbafflespresent? - - ----- -- - --- - - - - - El ❑� El
24"access risers over each compartm - ❑ UI ❑
lLI ; Effluent filter installed?-- - - ------- - - - - - -- -- - - -- - - - ❑ III ❑
Septic tank capacity(working) 1,250 gal Manufacturer Hagerman
W D-box water level and speed levelers used? -- ---- --------- ❑ NSA ❑ YES ❑■ No
D, Manifold/D-box accessible from surface?-- ------- - - - - ---- ❑ El ❑■
OLL
Checkvalvesinstalled? -- - - - - - --- - - - - - ----- - -- - -- ❑ U] El
Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑3 UI 4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.fromfoundation?-- --- - - ---- - - - - ----- ------ ❑ N/A lYES El NO
>100ft.fromwells?------ -- -- --- ---- - -- - ------ -- ❑ ■❑ ❑
d&1.;
>100ft.fromsurfacewater?- --- - - - - ---- - ------ ----- ❑ 0 ❑
t� >10ft.frompotablewaterlines?- -- - ---- ----- - - - - ---- - ❑ ❑e El
> 5 ft from property lines and easements?----- - - - - - ------ El UI El
>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?- -- - --- ---- --- - -- -- ❑ I El
Pump tank setbacks consistent with septic tank?-- -- -- - ---- -- El NIA Q YES ❑ NO
Pump tank capacity(flood) 1,250 gal Manufacturer Hagerman
24"access riser(s)and accessible from surface? ---- -- ------ El ® El
Alarm or Control Panel Installed? - ----- - - - - - -- - - - - - - --
❑ ® El
Control Panel equipped with Timer/ETM/Counter--- - - - - -- - - ❑ ® ❑
sue :
Pump installed in ❑ Bucket or 0 On Block or ❑ Other
O' f Pump Make/Model Liberty FL102M-2 Floats or ® Transducer
❑
Tank draw down 4.1 in/min Pump capacity 90 gpm Squirt Height 6.5 ft
Pump on time 1.3 min Pump off time 6 hr Daily flow set at 480 gpd
Updated 8212018
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Mason County OSS Installation Report pg. 2 Parcel# 3200$- 4=2- 900
ABANDONMENT RECORD
?
Were existing septic components abandoned as part of this project? ------------- -- ❑ YES g NO
If yes, please describe:
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,a fisting and proposed buildings,location of wells,waterlines,
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
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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 info ation contained on this I further certify that all information contained on this
forma itached R ord Drawl ccurate. form and attached Record Drawing is accurate.
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f nature of Installer Dale
G ILLI Lt\ND
Printed Name of.Signee he as wait
MASON COUNTY PUBLIC HEALTH
The undersigned approves this installation Report and
I.'
Record Drawing on behalf of Mason County Public C PAULA JOY JOHNSON
Health: �_ I fC � Lire ? "'
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EXPt-FZESZJ91151
Signature of Environmen /Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 821/2018
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