HomeMy WebLinkAboutSWG2025-00312 - SWG As-Built - 5/27/2026 {
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANTI PERMIT INFORMATION
Permit Number SWG 2025-00312 Parcel# 52112-31-00210
Applicant Name Bryan James Subdivision (Name/Div/Block/Lot)
Applicant Address 5070 W Skokomish Valley Rd. TR 21 OF E1/2 SW
City, State, Zip Shelton, WA 98584 Installer Name House Brothers
Site Address same Designer Name Arrow Septic Designs
INSTALLATION CHECK IST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only EI Repair ❑Other
System Type Shallow Pressure Trench retreatment Type
>5 ft. from foundation? -- - -- - - ❑ NIA 0 YES ❑ No
>50ft.fromwells? --- - - - -- {-J - -- -L------ - --- ❑ r ❑
>50 ft.from surface water? -- - - -1 2Q2 - - - - - ❑ II ❑
Cleanout between building and to ----- - - ----- ------ ❑ II ❑
Tankbafflespresent? - - - -- - -- - - - -- - ---- ❑ ❑ ❑
By
24" access risers over each comp --- ---- --- ❑ 0 ❑
MWEffluentfilterinstalled?--------- -- - -- - - -- - - - -- -- - - ❑ ❑
_ _ a Septic tank capacity(working) 1,250 gal Manufacturer HB Tanks
a D-box water level and speed levelers used? - - - ----- ------- ❑ N/A ❑ YES 0 NO
. Manifold/D-box accessible from surface?--- - - - -- - - - -- ---- ❑ 0 ❑
O LL
Check valves installed? -- -- - - - - ---- - - - -- -- - - --- - - ❑ 0 ❑
Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.fromfoundation?- --- - - - -- - - --- - - - - --- - -- -- - ❑ N/A MYES LINO
>100ft. fromwells?------ ---------- - - --------- -- ❑ ❑■ ❑
>100 ft.from surface water?- - - -- - - ----- - -- -- ------- ❑ ❑e ❑
>10 ft.from potable water lines?- - - - ---- - - -- ----- ---- - ❑ 0 ❑
5 ft.from property lines and easements. ❑ 1k El
> 30 ft from downgradient curtain/foundation drains?-- - - - - -- - - ❑ 0 ❑
_7,y Drainfield level and observation ports present - - -- -- - - - --- -- ❑ ® ❑
❑ Graveless chambers or ® Clean gravel used? (check one)
._.,' Proper cover installed over drainfield?---- - - ---- ------- -- ❑ 0 ❑
Pump tank setbacks consistent with septic tank?-- ----- ----- ❑ N/A UI YES ❑ NO
Pump tank capacity(flood) 1,250 gal Manufacturer HB Tanks
24"access riser(s)and accessible from surface?-- --- --- -- --- ❑ ® ❑
d—
aY AlarmorControlPanellnstalled? -- - - -- - - - - - - - - - -- - --- ❑ ® ❑
Control Panel equipped with Timer/ETM/Counter-- - - - - - - - -- O ® ❑
A Pump installed in UI Bucket or [] On Block or ❑ Other
Pump Make/Model Liberty 290 0 Floats or ❑ Transducer
Tank draw down 3 in/min Pump capacity 66 gpm Squirt Height 5 ft
Pump on time 1.8 min Pump off time 6 hours Daily flow set at 480 gpd
Updated 821/2018
Mason County OSS Installation Report pg. 2 Parcel# Z"3 I - 002to
ABANDONMENT RECORD 0
Were existing septic components abandoned as part of this project? -- YES 0 NO
If yes, please describe:OLD TMK 'S AC a �S �i O(-
Were all components pumped out and properly abandoned per WAC246-272A-0300? ------- - YES 0 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,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.
Oftic/O \Ld
Record Drawing Attached
CERTIFICATION-OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
/certify that/installed the system in accordance with /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-in formation contained on this I further cert6j that all infornrafi^n_contained-on.fhis
form a attach,6d Record Drawing is accurate. form and attached Record Drawing is accurate.
Signat re of Installer Date
Printed of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Re n
Record Drawing on behalf of Mason County ublic 1� 5100349 .'•,l1yj
Jl PAULAJ0YJ0HN5AN
Healt . qsD ? � Lt FENS ti t�Ml=fit.
Signature of Environmental Health Specialist B 414 (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FO �d 4IC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2112018
NOSNHor Aor vinbd
V I \ T =1 . \
St
Q I -- I
it 1 (g oJ
gog. 1 • TZT-
O =O'J aai2!i
ii OJ
iq ar LOS 00ZL Q
v'��
X7-7 1a?.ir�►1. a z Y tt — —- - g-tM�
Via.3PPS '=OM 00Z. �£ 1 . °'' W(
• Cn
9�o� = Z Nn00NOSV i I rn•�•0�4
. ��
• •- \ ' *:;' \ 3
moo _
•- ••
- S I
G