HomeMy WebLinkAboutSWG2026-00095 - SWG As-Built - 5/7/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
PP AsT!PERMIT INFORMATION '.u.
Permit Number SWG 2026-00095 Parcel# 32127-53-00026
Applicant Name Always Painting &Construction Subdivision (Name/Div/Block/Lot)
Applicant Address 301 E Wallace Kneeland Blvd LAKE LIMERICK 4 LOT:26
City, State, Zip Ste 224, PMB 38, Shelton, WA Installer Name Maples Excavating
Site Address 10 E Barnsby PI, Shelton, WA Designer Name Arrow Septic Designs, Inc
INSTALLATiON CHECKLIST
❑ Full System Installation Q Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Existing Gravity Trench P tment Type
❑ N/A ®❑YES ❑ No
r ? -- - - - - - - - - - - -'� s
�� >50 ft.from.wells. -- �` ❑ ❑ ❑
>50ft.from surface water. -- - - - - - ,- -
-- %i - ❑ ❑ ❑
itl' ---- ■
Cleanout between building and tank? - -- ;,�.- �1 (- -'--- ❑ ❑ ❑
Tank baffles present? - - --- - - - -- - -r"4" - - - -- 0 ❑
24 access risers over each compartment?;- -- - : _- ❑ 0 ❑
W 3Effluentfilterinstalled?--- -------- ------ - - -- - - - - - ❑ ❑
Septic tank capacity(working) 1,200 gal Manufacturer Hagerman
D-box water level and speed levelers used? -- -- --- - - - - ---- - N/A ❑YES ❑
Manifold/D-box accessible from surface?--- - -- ---- - - ----- ❑ ❑
Check valves installed? -- --- - - -- - - - - - -- - --- - --- -- ❑ ❑ ❑
Ci�t
Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commerc Other
>10ft.fromfoundation?-- - - - -- ---- - - - --- ---- -- - - ❑ NSA ❑ YES ❑ No
r� :>100ft.fromwells?------ -- ----- --- - --- ------- -- ❑ ❑ O
>100ft.fromsurfacewater?-- - -- - -- --- - --- --- - -- - - - ❑ ❑
u. = >10ft.frompotablewaterlines? - - - -- -- - -- --- - - - - - - - ❑ ❑ ❑
> 5ft.frompropertylinesandeasements?-- - - - -- - - -- - - - - ❑ ❑ ❑
> 30 ft from downgradient curtain/foundation drains?-- -,A'-- - - - O ❑ ❑
Drainfield level and observation ports present - - - - -y"- - - - ---
❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel us ? (check one)
Proper cover installed over drainfield?--- - - - --- -- --- -- - - ❑ ❑ ❑
Pump tank setbacks consistent with s is tank?-- ---- - ------ O N/A ❑ YES ❑ NO
Pump tank capacity (flood) gal Manufacturer
24" access risers and acc ible from surface?-- --- -- - ----- ❑ ❑ ❑
kW
�WYsAlarm or Control Panel stalled? -- --- - - - - --- -- - - - - -- ❑ ❑ ❑
Control Panel eqjpØed with Timer/ETM/Counter- - - - - - - -- -- ❑ ❑ ❑
Pump install in ❑ Bucket or ❑ On Block or ❑ Other
Pum ke/Model ❑ Floats or ❑ Transducer
P
Jz1draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 6/21/2018
1
Mason County OSS Installation Report pg. 2
Parcel# 3 2.4 Z"1 - 5� - oo2fo
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? --------------- O NO
e ic -�,xnl� a� re>^novd
if yes, please describe: YES NO
Were all components pumped out and properly abandoned per WAC246-272A-0300? ------
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,epsting and proposed buildings,location of wets,waterlines,
welts,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 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
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
/e24/2j4,
Signature of Installer Date
Printed Name of Signee @ y'
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public '.� 5100349
PAU0Y JOHNSON
Health: L'fC it M-91'',Vw hSignature of Environmental alth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8212018
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APPROVED
Y 07 2026
� PAULA JOY JOHNSON
MASON COUNTY ENVIRONME NTAU bEAU�H LiC�ss iat) �i��a�
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