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HomeMy WebLinkAboutSWG2025-00224 - SWG As-Built - 5/7/2026 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG 2025-00224 Assessor Parcel# 220121290114 Applicant Name MIKE GLASER Subdivision (Name/Div/Block/Lot) Applicant Address 1450 E BALLOW RD City, State, Zip SHELTON, WA 98584 Installer Name WORKMAN CONTRACTING Site Address 1450 E BALLOW RD Designer Name ADAM HUNTER INSTALLATION CHECKLIST 0 Full System Installation ❑ Septic Tank Only ❑ Drainfield Only ❑ Repair System Type GRAVITY TRENCHES 1treatmente Type N/A >5ft.fromfoundation? ----- - - - --- ' �'1 - ❑ N/A EYES fl NO >50ft.fromwells? -- - - - - - - -- - - - - - --� i f43 0 ❑ j '! Z >50 ft.from surface water? - - - -- - - °� - - - ,!fi� ❑ 0 ❑ Cleanout between building and tank? - s- - - - a -'r 7��� t�/I ❑ T ? - - - - -- U ankbafflespresent. ❑ ❑ a24" access risers over each compartment?-- - - - - ❑ 0 ❑ W Efuentfilterinstalled?- - - - - - - - - -- -- - - - - - - - - - U O ❑ N 1500 SOUND PLACEMENT Septic tank size gal Manufacturer 0 D-box water level and speed levelers used? - - - - - - - - - --- - -- ❑ N/A 0 YES ❑ NO 0O Manifold/D-box accessible from surface?- - - - - - - - - -- - -- - -- ❑ 10 ❑ QQ Check valves installed? - - - - - - - - - - - - - - - - -- - - - - - - - - 0 ❑ ❑ 4" 2 Transport Line Size Schedule/Class 3 03 L Bedrooms.installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 >10 ft.from foundation?- - - - - - - - - -- - - -- - --- - - -- --- ❑ N/A [ZYES ❑ NO >100ft. fromwells?-------- - --- - ---- ------- ----- ❑ 0 ❑ W >100ft. fromsurfacewater?-- -- - - - - ---- - ------ --- -- ❑ 10 ❑ M >10ft. frompotablewaterlines?- -- - ----- - - ------ --- -- ❑ ❑ Z > 5 ft.from property lines and easements?- - -- - - - - -- --- - -- ❑ O ❑ >30 ft.from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ❑2 ❑ Drainfield level and observation ports present - - - - - - - - - -- -- - ❑ 0 ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- --- -- - ---- --- ----- ❑ Q ❑ Pump tank setbacks consistant with septic tank?-- -- - -- -- ---- 0 N/A ❑ YES ❑ NO `-� Pump tank size N/A gal Manufacturer N/A Q24" access riser(s) and accessible from surface?----- - ------- ❑ ❑ D. Alarm or Control Panel Installed? --- - - - - - - - - - ---- -- --- ❑J ❑ ❑ Control Panel equipped with Timer/ETM/Counter - - - - - - - - -- ❑ ❑ ❑ a- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other N/A CLPump Make/Model N/A ❑ Floats or ❑ Transducer d Tank draw down N/A in/min Pump capacity N/A gpm Squirt Height N/A ft Pump on time N/A Pump off time N/A Daily flow set at N/A gpm revised 1/22/2014 r � Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as rt of this project? -------------- - © YES ❑ NO If yes, please describe: $co - rZi Were all components pumped out and properly abandoned per WAC246-272A-0300? ------- - YES ❑ NO RECO.RDDRAWING 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 lank location,North arrow,reserve drainfield,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. 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. ltd nt 5/7/26 �t�. Signature of Installer Date Printed Name of Signee 05/.07/26 MASON COUNTY PUBLIC HEALTH ""• The undersigned approves this Installation Report a Record D g on behalf of Mason County Public (�R f n Health ��✓ { � _ 'u:,' rTud.uuNTEI, j((f(77co 8 ?o< �//,7 n 'sJ"Y/ //ll •I��•�i7315JtiU�1^CjCi\l Sig ature of Environmental Health Specialist Date /R0, (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABI FOR P66f.I VIEW ON THE MASON COUNTY WEB SITE Updated 82112018 7( O N SEE DETAIL µ I ���1 6 i�I l 1 � IILIII I 1 Q 3 1075± xoc EXISTING TIGHTLINE FROM SHOP NOTE:INSTALLATION DEPTH TOO DEEP ON THE WEST LATERAL,INSTALLER WORKED EXISTING 3 BEDROOM RESIDENCE WITH MASON COUNTY FOR A WAIVER AND INSTALLED"VENT PORTS"AS A PART OF THE MITIGATION. EXISTING SHOP W/CONVENIENCE RESTROOM 3O EXISTING CARPORTS DRAINFIELD AREA TANK DETAIL-NO SCALE O5 MAN MADE POND/WATER FEATURE WITH LINER DETAIL- JIM I r Rc EXISTING DRIVE OrJtQ7I26 EXISTING WELL OB EXISTING STUBOUT/CLEANOUT(IE.-98.0) P P R O V ;,� '� _ �„E,"„� _______ __- JHf Og EXISTING SEPTIC TANK(ABANDON PER CODE) RECORD 10 YSEPTIC TANK MAY 19 2026 "'C� '�•• � OWNER "D"BOX AOAffJ.UUYTRE 11 4"TIGHTLINE TO"D"BOX %5, ON COUNTY ENVIRONMENTAL HEALTH �cJ�rc 12 13 DRAINFIELD DJA TP#