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HomeMy WebLinkAboutSWG2025-00362-ASBUILT - SWG As-Built - 7/8/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2025-00362 Parcel # 22024-78-90021 Applicant Name Amy Bond Subdivision (Name/Div/Block/Lot) Applicant Address 2221 E St Andrews Dr N City, State, Zip Shelton, WA 98584 Installer Name County Line Development, LLC Site Address 801 E Jared Rd, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Trench Pretreatment Type >5 ft. from foundation? - - - - - - - - - - - n i ❑ NIA ■❑ YES El NO >50 ft. from wells? - - - - - - - - - --- - --I W ❑ ❑ Z >50ft. fromsurfacewater? - - - --,- _JU- - - - ❑ FE ❑ Cleanout between building and tank? - - - L 1 57,f1Zft - LI ❑ F ❑ Tankbafflespresent? - - - - - - - - - - - - - - - - - - - - - - ' ❑ 0 ❑ 24" access risers over each compartment. - - -, L- -Y - - - ❑ 0 ❑ W- Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ UI ❑ Septic tank capacity (working) 1,250 gal Manufacturer Infiltrator O D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A ❑ YES No J Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ LII ❑ mz Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ II ❑ oa Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 W 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ❑j YES ❑ NO >100ft. fromwells?- - - - -- - - - -- - - - - - - - - - - -- - - - - - - ❑ 0 ❑ >100ft. fromsurfacewater?- - - - - - - - -- - - - - - - - - - - - - - - O 1.11 ❑ ti >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ ■❑ ❑ Z > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ III ❑ W > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ I ❑ 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 Q YES ❑ NO Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator d; 24"access riser(s)and accessible from surface?-- - - - - - - - - - - - ❑ © ❑ a Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ LII ❑ E Control Panel equipped with Timer/ETM /Counter- - - - - - - - - - - ❑ © ❑ D Pump installed in ❑ Bucket or © On Block or ❑ Other a - Pump Make/Model Zoeller N152 Floats or ❑ Transducer Tank draw down 1.75 in/min Pump capacity 50 gpm Squirt Height 11 ft Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 2-2 02.'k--i`g— c OOZ :ABANDONMENT QECORO Were existing septic components abandoned as part of this prom - - ------- if yes, please describe: DYES ❑ NO Were all comppumpednents au out and properly abandoned per WAC246-272A-0300? ------ RECORD DRAWING acrivides and fu�tte nL Typ T2Ha�d reco+d and!Host be accurate and desCZ PtiVe enw:9h to re-looate the need o*rnairsttna a to�fiart of rrel,waterlines, ffwets, is?p sar erct rw drz asks,esstiru,ants l Esdngs. cwtaln: Oratns)+c&mani(n!d wie:rta5on&1a .SeP' R� tank bc�t on,North a*va,rase and related peen ts. sery Porgy.deanouts,and oeMr rt aznt nance mess Pi's• IRGxnptiL'�Re""•^.r= r<aY axe a,�.xtsa7'+daYs¢m fina3 irt52a1}dCOn appovat Record Drawing Attached CEF f1CAT1ON OF INSTALLATION INSTALL-ER DESIGNER!ENGINEER I certify that 1 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 1 fu re that all information contained on this i further certify that all information contained on this fohedRecord Drayvig is accurate. form and attached Record Drawing is accurate. 2Co Signature of Installer Date tl MICHAEL LOVELY Punted Name of Sigr?ee ` MASON COUNTY PUBLIC HEALTH The undersigned approves this installation Repo, and rfr��' s�oo3as S '� `1\ Record Drawing on behalf of Mason County Public j J'Z PAULA JOY JOHNSON �r Health: IL' 1=GUE�Sl�tJ�R.. �� � , • / f17 7 co ✓ Signature of Errvranmentai Health Specialist (stamp,signature and date) THIS FORM MAY BE SCANNED AN6) F FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Uma anll20ta q�Ty j ! i /oo / S,�> ^c� , 3 744 / \ ( (7 � I ( ) 3' SC r� Q� D.F. NN 5 .G. tP=TM SO SL D rti 11 AL'&O-ViSZI-1 ^--rte. `o C1ea ^�_. .e, 111 0 1200 c- lo= Sep-cc Tank1` N _ 7 uezitFflter 3 i s i 1200 c— o-Pp Came= 'Tr :SOX }� {� Valve Co j I 2 i5 I C cCSA S, JQ nA�L —�lM Z v'3 �i. l-i llzuc-1ixF 5i�ND 2 r �G l � c�l4K� KrJ _�� ✓ s�-� ::0 1-r: . ;�:E-T'F� Ste:: 44; 4 °Nc°v Z9 'Y�F ?O�U ,v/Gi�••. 5100349 •' `{rj\ �`� ° QZ PAULA JOY JOHNSON MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2025-00362 ADDRESS: 801 E Jared Rd PARCEL: 220247890021 DATE: 7/2/2026 L__ HOUSE TO DRAINFIELD DRAINFIELD TO HOUSE Ka• Ia Milam From: Sent: DO NOT REPLY To: y more I Thursday, p y@masoncountywa.gov> July 2, 2026 6:00 AM Subject: Environmentalhealth OSS Inspection request for amy bond - swg2025-00362 Submittal request for: amy bond Site Address: 801 jared rd Permit Number: swg2025-00362 Parcel Number: 22047890021 e}, lla16 r Installer Name: michael lovely \` Installer Phone Number: 3602920909 Installer Email Address: MIKE@COUNTYLINEDEVELOPMENTLLC.COM Designer Name: paula johnson Designer Email Address: paulaj@hctc.com Inspection Request Date: 2026-07-02 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 e submitted for final installation approval.