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HomeMy WebLinkAboutSWG2025-00275 - SWG As-Built - 6/10/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 1025-00275 Parcel# 421227590072 Applicant Name Todd Hubble Subdivision (Name/Div/Block/Lot) Applicant Address 51 E DUNOON PL TR7-A-2 OFSURV12124TRAOFSP#1769TRA-2 OFSP#27804634270 City, State, Zip SHELTON WA 98584 Installer Name Rich Moore Site Address 881 Eagle Point DrSHELTON WA 98584 Designer Name JimZimny INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pressure Distribution Pre eatment Type 0 N/A •YES ❑ NO >50ft.fromwells? ----------- t�i - © ❑ z >50 ft.from surface water? ------ - �-'j- - (p - - ❑ © ❑ HCleanout between building and tank? ---------------- ❑ Iii ❑ V Tank baffles present? -- ----- -- - - - - - -- ---- ❑ ❑ 0~. 24"access risers over each compartme -- ------- ❑ ® ❑ W Effluent filter installed?----- --- --------- ---------- ❑ ® ❑ Septic tank capacity(working) 1250 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? --------------- 0 N/A ❑ YES ❑ NO �O Manifold/D-box accessible from surface?-- - ------ ------- - ❑ ® ❑ Q? Check valves installed? -- ----- -- - - -- ❑ 0 ❑ - --- ------- -- OQ Transport Line Size 2" Schedule/Class sch 40 Bedrooms installed (check one) ❑ 2 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?----------- ------ -------- - ❑ N/A AYES ❑ NO >100ft. fromwells?-- ------------- -------------- ❑ ❑■ ❑ W >100ft.fromsurfacewater? ------------------------ ❑ ® ❑ >10ft. frompotablewaterlines?---------------------- ❑ ® ❑ >5 ft. from property lines and easements?---------------- O © ❑ >30 ft.from downgradient curtain/foundation drains?---- ------ ❑ 0 ❑ Drainfield level and observation ports present --------- ----- ❑ ® ❑ J Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed overdrainfield?------------- ------ ❑ 0 ❑ S. Pump tank setbacks consistent with septic tank?------------- ❑ N/A YES ❑ NO Pump tank capacity(flood) 1000 gal Manufacturer Infiltrator Q24"access riser(s)and accessible from surface?-- --- -------- ❑ © ❑ ~ Alarm or Control Panel Installed? ---------------- ❑ II ❑ Control Panel equipped with Timer!ETM/Counter--------- -- ❑ 0 ❑ Pump installed in ❑ Bucket or 0 On Block or ❑ Other Pump Make/Model liberty 280 J Floats or ❑ Transducer a Tank draw down 1" in/min Pump capacity 27 gpm Squirt Height 8' ft Pump on time I min 40 secs Pump off time 4 hrs Daily flow set at 270 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 7I ?7 S— co 7.Z ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- ❑ YES No If yes,please describe: Were all components pumped out and property abandoned per WAC246-272A-0300?-------- O YES D NO RECORD DRAWING This Is a permanent record and must be accurate and doscripf ve enough to ro•Iocate in the need of matntenanc activities and futu►o dwetopment. Typ:cd Record ormmrps comae orortrud a manddd onentabon&layout.SepbC ump tank tocotion.NoM enoure rosorva drabdlietd.osetng and proposed twitdutgs.Motion orwetls.rraterVnes• webs.obs mton ports,cteenouts,end other muntenonce access points. Incomplete Record prardngs may txeato oddilionol delays in tint installation opprovr and related parrots. ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that!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 t at all in! Lion contained on this I further certify that all information contained on this to=naffia, d Re ing is accurate. form and attached Record Drawing is accurate. 5-70 2c2 Signature of Installer Date f, Zf9 - r .v.r^! r Printed Name of Signee MASON COUNTY PUBLIC HEALTHtl4, The undersigned approves this Installation Reports 3d �� r Record Drawing on behalf ojpason County Pubh a 1 . t Health: '9Sp ✓(0 LICE SEDDEfR Signature of Environmental Health Specialist 'P ifl�o, c p (stamp,signature and date) THIS FORM MAY BE SCANNED AN61AVA ' 'C ,FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Wwctl w2l- 10 Scanned with CamScanner AS-BUILT county stamp JUN 10 26?6 MASON COUNTY ENVIRONML NTAL HF OU4 Design1tamp 22' So' S/0 EL 317' 1- 1250 septic Tank SFR O 1 2-1000 Gallon Pump Tank O 3- Hydrosplitter a DESIGNER O 2 -Zc•2 (p 8 Designer Info: Jim Zimny APD 12' 7178 Windflower PL NW Seabeck,WA 98380 r • rl APDdesignsaicloud.com r i to Applicant Info: TODD HUBBLE t I 881 Eagle Point DR m rn ' i a ^' Shelton WA to . 2 #42122-75-90072 r i i I f 3 i . Date: --- -------------- --------------------END Dat NA 3/19/2026 LEG 88 - B chM Pa9 e 1 30' RD EASEMENT oil to i e1330 102' roperty Line Scale Qo,�� Power Line 1" =30' Water line Not A Survey