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HomeMy WebLinkAboutSWG2026-00200 - SWG As-Built - 7/16/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2026-00200 Parcel # 322195300003 Applicant Name Jeff Sanders Subdivision (Name/Div/Block/Lot) Applicant Address 451 NE LANDON RD BALD POINTE AERIE LOT 3 City, State, Zip BELFAIR WA 98528 Installer Name Arron Shoemaker Site Address 71 NE Bald Pt Rd Designer Name Jim Zimny INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only El Drainfield Only ❑Repair ❑Other System Type Gravity distribution Pretreatment Type >5 ft, from foundation? - - - -- - - - - -- -r - ❑ N/A ® YES ❑ NO >50ft. fromwells? - - - -- - - - - - - - - " I. 0 ❑ >50ft. fromsurfacewater? - - - - - - - - - I- - -r ® ❑ Z FQ- Cleanout between building and tank? - - - L, ------- - -- - - - *1 ❑ O Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - ❑ d24" access risers over each compartment? ® ❑ W Effluentfitterinstalled?- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ Septic tank capacity (working) 1050 gal Manufacturer Roth D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A ® YES ❑ NO QO Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ U ❑ mZ Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - 0 ❑ ❑ 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - - - - --- - - - - - - - - _ N/A © YES NO O >100ft. fromwells?- - - - - -- - - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ W >100ft. fromsurfacewater? - - - - - - -- - - - - - - - - - - - - - - - ❑ ® ❑ u. >10 ft. from potable water lines?- - - - - - - - - -- - - - - - - - - - - - ❑ ® ❑ Q > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ © i1it ❑ ly > 30 ftt from downgradient curtain/foundation drains? - - - - - - - - - - ❑ © " ❑ Drainfield level and observation ports present - - - -- - - - - - - - - - Li 0 5 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - - _ ❑ K �4 ❑ Pump tank setbacks consistent with septic tank?- - - - - - - - - - - - - N/A ❑ YES ❑ NO Pump tank capacity (flood) gal Manufacturer___________________________________— < 24" access riser(s) and accessible from surface?- - - - - - - - - - - - - ❑ ❑ ❑ a Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - _ ❑ ❑ ❑ 2 Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - ❑ ❑ ❑ Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Pump Make/Model ❑ Floats or ❑ Transducer f Tank draw down Z in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Mason County OSS Installation Report pg. 2 Parcel a �V S "Ck cic)3 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ----- - - - - --- - - - 0 YES ® NO If yes, please describe: Were all components pumped out and properly abandonedt per WAC246-272A-0300? 0 YES ® NO RECORD D AWING This Is a permanent record and must be accurate and descriptive onough to ra-local.In the n..d of maint.nsnc.activities and future development, typ,cnl Rtx:onl Drawings contain. Drainheld&manifold orientation&layout.Septic'pumn tank local,n Pot- rr„,, ienn,a drainkeki.eats-rng and proposed buikimgs,iucatwn of wets wetedl•ies wells.observation ports,cieanouts ,,rd other maintenance access pants. Into' Jets Ra'rc I) sings r:av'Bate atidrtwnrd rtel.'rya in tint'nslaiahor approval and rebind perry Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI ENGINEER /certify that I installed the system in accordance wito 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 Courty Public Health and that any deviations show'; Mason County Public Health and that any deviations here.iave been cleared/approved by both tho designer shown here have been cleared/approved by both !,ti Mason County Public Health and mee'all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes t further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is ai ri,,-ate. form and attached Record Drawing is accurate. ure of Installer �' D e/4'l_c Panted Name of Signee V Y Z� MASON COUNTY PUBLIC HEALTH S The undersi signed approves g this Installation Report and t •�•<� �• ,,� Record Drawing on behalf of Mason County Publich\3w Health: ,�� ifr ( SignaIwxi of Environmental •ew-/,Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILAt3LE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE undt a 4;r;)t,8 ASbuilt North EL 165" 223' Abandoned septic Tnk el �`o�e o deck % Ln oho 1 1 1 N \ e el 135' AP KbVED ifs\ t Pin Located JUL 2 9 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET Date: 7/15/2026 Datum NAD83 Designer mp Designer Info: Applicant Info: Page AJPnDZimny O'Neill SOILLOG Mar � 7178 WindilowerPLNW 71 Bald Pt Rd — Property Line Scale r u Seabeck.WA 98380 TAHUYA WA 9858 -•_ P v Property L ne # 322195300003 - - ater ine 1„ = 30' LICENSED DESIGNER APDdesigns(tricloud.com Not A Survey Kayla Milam From: DO NOT REPLY <noreply@masoncountywa.gov> Sent: Wednesday, July 15, 2026 2:40 PM To: Environmental health Subject: OSS Inspection request for O'NEIL Aaron &Julie E - 2026 00200 Submittal request for: O'NEIL Aaron &Julie E Site Address: 71 NE Bald Point CT Permit Number: 2026 00200 Parcel Number: 322195300003 Installer Name: Shumaker Construction Installer Phone Number: 360 509 1222 Installer Email Address: atshumaker@msn.com �Uj : , Designer Name: Jim Zimny e 152026 g Designer Email Address: apddesigns@icloud.com Inspection Request Date: 2026-07-16 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. • • MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2026-00200 ADDRESS: 71 NE Bald Pt Rd PARCEL: 322195300003 DATE: 7/16/2026 41 $04 HOUSE TO DRAINFIELD /: fL ___ DRAINFIELD TO HOUSE