HomeMy WebLinkAboutSWG2026-00120 - SWG As-Built - 6/3/2026 Mason County OSS Installation Report pg. 9 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG -LOZC�,•- s 0/ 1�- Parcei#_ ,a0 I -i ai
Applicant Name Lo c Lnt -axU 't ti` t/-'� -� Subdivision (Name/Div/Block/Lot)
Applicant Address 131 (' dI ►w Q.
City, State, Zip W fl %SSW Installer Name
Site Address i Ttt 1 F' pl(1 pct )- Designer Name
iNSTAL.LA7'IOhI CHECKLIST
Dull System Installation [l Tank(s)Only ❑ Dralnfield Only ❑Repair ❑Other
System Type t &L O tment Type (U/
>5 ft. from foundation? - - - -- - --- - ❑ N/A [Tves ❑ NO
>50 ft. from wells? - - - - - - - - - - - - - - - - - -_ - _ ❑ 9/ ❑
>50 ft. from surface water? - - - - - - - --tAL 2 J_ZD2�.-- ❑ c..r ❑
4 Cleanout between building and tank? - - --- -- - - - ---- . ❑ ❑' ❑
Tank baffles present? - - - - - - --- - - - - - --. ❑ ❑w ❑
24" access risers over each compartmen B� --- - -- - ---- ❑ [� ❑
UEffluent filter installed?- - -- - - - - - - - - - - -- - - - - - - - - - - - ❑ El
Septic tank capacity(working) • I l ti gal Manufacturer ti. .Y' ciM i u
o D-box water level and speed levelers used? -- -- -- - - - - --- - - D'-N/A ❑ YES ❑ NO
9O Manifo►d/D-box accessible from surface? - - - - - - - - - - - - - - - - ❑ ❑
QCheck valves Installed? - - - - - - - - - - - - - - - - - -- - - - - - -•- ❑ [f El
Transport Line Size _ -' Schedule/Class '-40
Bedrooms installed (check one) Pi1i O O 0 El ❑Commercial/Other
>10 ft. from foundation?- - - - - - - - - - - - - - - - - --- - - ----- ❑ N/A [9'4ES [] No
In >100 ft.from wells?-- -- - - -- -- - - - -- - -- ---- ------- - -- ❑ [E' ❑
-t >100 ft.fromsurfacewater? - - - --JUN - - -- ❑ 0" L]
L ' . 2f --. ❑ ❑d
M >10 ft.from potable water lines?.----- ------------- - -
> 6 ft.from property lines and ease m� t�Qt�I� l�� lEfaTA� ❑ I3 ❑
W >30 ft.from downgradient curtain/foundation drains?-W------- O vi' ❑
Dr,frnfleld level and observation ports present -- - - --- - --- -- - - ❑ En" ❑
[ Graveless chambers or [.� Clean gravel used? (check one)
Proper cover installed over drainfiold?- ---- --- - - - - - - -- - - - - ❑ ['I O
Pump tank setbacks consistent with septic tank?- --- - - - -- — - - ❑ N/A [21'ves ❑ NO
Pump tank capacity(flood) 0 gal Manufacturer to ii "t 0L
H24"access riser(s)and accessible from surface? - - -- - - -- - - - ❑ El ❑
o.. Alarm or Control Panel installed? -- - - - - - - - - - - - -- - - - - - - - ❑ ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - -- - - - ❑ C" ❑
9- Pump installed in ❑ Bucket or [v}sOn Block or ❑ Other
Pump Make/Model L? - '- Sd ['Floats or ❑ Transducer
tL Tank draw down '- 3 in/min Pump capacity ` 1?�
� p ry�_-gpm Squirt Height � ft
Pump on time '►__ Pump off time._ J R5 Daily flow set at a�d gpd
Updated W2112010
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Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -- -- ------- - - - - ❑ YES ( 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 end descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record
Drawings contain: Drainfeld&manifold orientation&layout,Septiclpump lank location,North orrow,reserve drainfleld,existing end proposed buildings,location of wells,waterlines,
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record orewings may create additional delays in final Installation approval and related permits.
v' I 44 M,S ✓U
ON"C4/NTyN41 j `�
TAl yF,���y
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.
Slgnaureoyy..inst �ler/a `
' ',,t Date
/9:. / 1
Fruited Name of Signee �`r" � ,;•
MASON COUNTY PUBLIC HEALTH ` 'u
The undersigned approves this Installation Report and
�• 5uu.ti2
Record Drawing on behalf of Mason County Public O; ADAM J,HUNTER
51 atu a Environmental Health Specialist Date (stamp,signature and date)
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 812 1120 1 8
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Kayla Milam
From: DO NOT REPLY <noreply@masoncountywa.gov>
Sent: Tuesday, May 19, 2026 7:11 AM
To: Environmentalhealth
Subject: OSS Inspection request for Lucinda Sowinski - SWG2026-00120
Submittal request for: Lucinda Sowinski
Site Address: 171 E old Farm RD Shelton WA 98584
Permit Number:SWG2026-00120
Parcel Number: 2201921044020
Installer Name:Josh Gunia
Installer Phone Number: 253-579-6769
Installer Email Address:jgunia@envirotechnw.com
Designer Name: Adam Hunter
Designer Email Address: adam@huntersepticdesign.com
Inspection Request Date: 2026-05-19
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 'Inspection
Request Date' and remain uncovered for three business days to allow staff time to inspect. Poor weather situations may
be accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer 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.
1
i J
INSPECTION PORTS!LAT.CLEANOUTS
330.0 1 13
SCALE: 1" = 100FT 10 / ' p
1' /
4 34. 1p I l /l RlP/l
3 / 6 / // / /34.0
/ /
10 EXIS ING FORCEM N
9y 5 / AP P 0 V E
D
/ JUN 03 3 "�2S
SEE ETAIL 1Q0 8
MASON COUNTY ENVIRONMENTAL HEALTH
O 12 JBW
SCALE: 1" = 30FT
657.0 11 657.0
N
1
2 ,L,y IAL HEALTH
W�w ioj9�21
rn APPROVE ID PRESSURE TEST COMPLETED BY INSTALLER:
0
0
JUN 032026 05/22/2026 SQUIRT HEIGHT: Fv
MASON COUNTY ENVIRONMENTAL HEALTHr �t' DRAWDOWN: L•
JBW TIMERSETLT,INGS-
Iy ON: _I i sec
a:i ,, t••,r,
EXISTING 2 BDRM RES
� x OFF: q NR-S
AtJAf.l J.IIIINTER '�
EXISTING WELL C119
330.0
:Evx�cx�cz.
EXISTING DRIVE
4O EXISTING STUBOUT/CLEANOUT
EXISTING SEPTIC TANK(LEAKTIGHT-CERTIFIED BY INSTALLER)
8O EXISTING 24"X48"PERMITTED PUMP BASIN W/GRINDER PUMP
PUMP CHAMBER
HUNTER SEPTIC DESIGN CONTRACTOR:
ENVIROTECH
2201 93rd Ave SW/Olympia,WA 98507 FORCEMAIN
360-890-2778/designs@hunterseptic.com INSTALL DATE: 5/18/26
DRAINFIELD AND RESERVE AREA SITE ADDRESS/LEGAL:
10 OUTBUILDINGS RECORD DRAWING FOR: 171 E OLD FARM RD
ENVIROTECH
11 WATERLINE FINAL DATE: 5/18//26
SITE/PERMIT#:
12 FAILED D.F.(DUE TO AGE-ABANDONED) PARCEL NUMBER:
13 RBM IS GROUND EL.@ T.H.2(RBM=100.0) 220192104020 2026-00120