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HomeMy WebLinkAboutSWG2026-00118 - SWG As-Built - 5/18/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00118 Parcel# 51908-50-00099 Applicant Name Wes Graves Subdivision (Name/Div/Block/Lot) Applicant Address 2272 E. Brockdale Rd Star Lake City, State, Zip Shelton WA 98584 Installer Name Wes Graves Site Address 124 W. Blakely Dr Designer Name N/A INSTALLATION CHECKLIST ❑ Full System Installation 0 Tank(s)Only ❑ Drainfield O epair ❑Other System Type Gravity ant Type >5ft. fromfoundation? ---------- - NIA AYES NO ❑ >50ft.fromwells? ------- ------ --- -- ❑ ❑■ ❑ Z >50ft.fromsurfacewater? ---- ----- -- -- ---- - UI ❑ H Cleanout between building and tank? ---'-- - ❑ 0 ❑ V Tank baffles present? ---- -- -- --- - -- --- - ---- ❑ ❑■ ❑ r24"access risers over each compartment?----9y -------- ❑ ■❑ ❑ W Effluent filter installed?--------------------------- ❑ 0 ❑ Septic tank capacity(working) . 1060 gal Manufacturer Roth Q D-box water level and speed levelers used? ---- ----------- ❑■ NIA ❑YES ❑ NO 9O Manifold/D-box accessible from surface?- ----- ----------- UI ❑ ❑ �Q Check valves installed? ---------- ----- ------ ---- - ❑■ ❑ ❑ g Transport Line Size Schedule/Class Bedrooms installed (check one) .12 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?-- - --------- ----- --- ------ ❑ N!A ❑ YES ❑ NO G >100ft.fromwells?--------- --i ---- -- - ❑ ❑ ❑ W >100 ft.from surface water? ------ — es❑ ❑ ❑ i >10 ft.from potable water lines?--- --- - D ❑ 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 ZPump to capacity(flood) gal Manufacturer Q 24" access risei )an&aecessJ.je from surface?------ ------ ❑ ❑ ~ Alarm or Control Panel Installed? - ❑ ❑ ❑ ------- ------ Control Panel equipped with Timer/ETM/ er- -------- ❑ ❑ ❑ 0- Pump installed in ❑ Buc or ❑ On Block or ❑ Other d Pump Make/Model ❑ Transducer" a Tank draw don in/min Pump capacity - gpm. 'Squirt Height: ft Pump on time Pump off time Daily flow set at - gpd updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 51908-50-00099 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- Q YES ❑ NO If yes, please describe: Existing tank was pumped out and removed Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- K■ YES O 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,Septiclpump tank location,North arrow,reserve drainfleld,existing 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. „ f 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 form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. LViZ2 gtaw G.O� 05-11-26 Signature o Installer Date Wes Graves Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: 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 RECORD DRAWING (continued) amt � l ti APPROVED MAY 18 2026 MASON COUNTY ENUIRON�4ENTAL HEALTH