HomeMy WebLinkAboutSWG2025-00460 - SWG As-Built - 6/10/2026 � .
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number swG 2025-00460 Parcel# 320215502022
Applicant Name CLD GROUP LLC, Subdivision (Name/Div/Block/Lot)
Applicant Address 100 N HOWARD ST STE R SHORECREST TERRACE 2ND ADD, Lot 22, Block 2
City, State, Zip SPOKANE WA 99201 Installer Name Mike Skinner
Site Address 231 E Wood Ln, Shelton Designer Name Jim Zimny
INSTALLATION CHECKLIST
UI Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pump to Gravity Pretreatment Type
>5 ft.from foundation? -- - - - ---- - - --- - --- - - - - -- - - ❑N/A ®YES ❑ NO
>S0ft.fromwells? - -- -- --- -- - �. � ®.�� ❑ ❑
z >50 ft.from surface water? - - - -- - ;,
Cleanout between building and tank? /J/4- -JUL ----- - ❑ ® ❑
Tankbaftlespresent? - - -- - - - - -- -- - - -u -2026- - ❑ ® ❑
d24"access risers over each compart en�tt?-- - - ------ ---- - 0 ® ❑
`W Effluent filter installed?- -- -- --- uy - - - - - - ❑ ® ❑
Septic tank capacity (working) 1000 Gallon gal Manufa er Hageerman
0 D-box water level and speed levelers used? -- -- --- --- -- - - - ❑ N/A ®YES ❑ NO
0O Manifold/D-box accessible from surface?- - - -- --- ---- -- - - • ❑ 9 ❑
QQCheck valves installed? -- - - - - - - - - - - - - --- - - - - -- - - - ❑ ® ❑
2 Transport Line Size 2" Schedule/Class sch 40
Bedrooms installed (check one) 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.fromfoundation?-- - - - -- -- - - - - - --- - - -- ---- - ❑ N/A ® YES ❑ No
>100ft. fromwells?- - - - ----- --- - - - - -- -- - - -- - - - - - ❑ ® ❑
W >100 ft. from surface water? --- - - ---- --- - -- --- ----- - ❑ ® ❑
M >10ft.frompotablewaterlines?- ---- - - ------ - - - ----- - ❑ ® ❑
Z >5ft. frompropertylinesandeasements?- - -- - - -- - - ---- - - O ® O
>30 ft. from downgradient curtain/foundation drains?-- -- - - --- - ❑ ® ❑
Drainfield level and observation ports present - - --- - - - - -- -- - ❑ ® ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?--- - - - ---- --- - --- - - ❑ UI ❑
Pump tank setbacks consistent with septic tank?--- - -- -- ----- ❑ N/A ® YES ❑ NO
Pump tank capacity (flood) 1000 gal Manufacturer Hageerman
Q24" access riser(s) and accessible from surface?----- -- - --- - - ❑ ® ❑
~
Alarm or Control Panel Installed? ----- -- -- - --- - - -- - - -- ❑ UI ❑
Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - ❑ U) ❑
ld Pump installed in ❑ Bucket or UI On Block or ❑ Other
a' Pump Make/Model Liberty 280
® Floats or ❑ Transducer
a Tank draw down 2" in/min Pump capacity 40 ppm Squirt Height N/A ft
Pump on time 1 min Pump off time 4 hrs Daily flow set at 240 gpd
Updated 8721/2018
Mason County OSS Installation Report pg. 2 If .$LOL 1 536 LOLL
ABANDONMENT RECORD
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RECORD DRAWING
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NR.+t nrtl I)rawevi AtL it"hi- I
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
1,v it,ty lh,tf I„itik,Nnd the sysfe+rr,n1 dt". Iitf nr,v ++rah I f erlfly(11,11 l(le sy:,terrt 11.C.be-en,,,Stalled In accol.
►ne septic des,gn stamped 'Af'f'ROVL 1) by Mason dance with the septic design stamped"APPROVED Lv
I (1unt) P,rhbt Hndlth drtd Ihdl,,it th,vrd(Itr,ts s1,,tw„ Mason Counts Public l4oallh anti(fiat.n1y d.,wdtiuns
lu s.+have btwil cln.arediappmved by both ltn,ofSrgrenr shown here have been cioalodlapproved by both
and Mason County Public Ilnaltli and mn.et all State tnysnlf and Mason Cnunly Piihhr, Hoalth and meet all
and Mason County(;odes State and Mason(,ounly Cndos
f If,sfho,certify that all eslf)fmobon c(urte'ned on Ilus t Irtrlikrr awfdy Us,st at'wti,nnation contain(!on the,
f(xm arul a(trrrhe:•d Ruv oid 1)rnw na r.,arrurale form.-)'in n1t.',ch ei.Rt,,-tnrl Ur,+v,nq s accurate
S'.,i.lcNP If Iiiildild: 1),,;,
.l 7V.Irlxr of Stgnra' 9
MASON COUNTY PUBLIC HEALTH
the under„gneft,r,tr fh,s Insinlab(xt Report irrid
Herold l:)rsiwing,:' ', ti.-ill of Mastul CtHJufy Nublrc 3
flPiirU, LI ESIGNER
Sal+rrafurt,off() inn.'-t )N5 ;',• sr,.1 I,,ff, (Shiti)p. Stg,,afn,e!slid date)
County Stamp
• ASBUILT North
109'
I ____________6' eslgnerp
7 ,. . . . . . . . ��
JO•................................................._____: . .. . . . . . . .:.:. . . 10' b�=�
o2 be �lli : e:. . . .:. • • •: M33
�Trn Allen.ZYvry
O • •••.• •• LICENSED DESIGNER
o Driveway ''2
. Designer Info:
Jim Zimny
0 0 APD
O 7178 Windflo,,ver PL NW
Seabeck,WA 98380
reserved 5' APDdesigns(d>,i.c1oud.com
5' 5'
Applicant Info:
109 LBD Group LLC
71 E Dalkeith Rd
Shelton ,WA 98584
Parkway Blvd
#320215502022
Da6/10/2026
LEGENDBe Ma
ratum k
Iark D83 � �QSd� Page
O Soil Log
^ N��NQ�� -�`
— Property Line �,11 CZQZ, � ' Scale
- - Power Line O�
--- Waterline
1" = 20'
Not A Survey
Ka la Milam
From: DO NOT REPLY <noreply@masoncountywa.g ov>
TSent: Thursday, June 11, 2026 10:34 AM
o:
Environmental health
Subject: OSS Inspection request for jim zimny - SWG2025-00460
Submittal request for:jim zimny
Site Address: 231 E WOODLANE
is
Permit Number: SWG2025-00460
Parcel Number: 320215502022 JUN ii
Installer Name: MIKE SIKINNER U /
Installer Phone Number: 360-516-7287
Installer Email Address: skinnersrinc@gmaiI.com
Designer Name: JIM ZIMNY
Designer Email Address: APDdesigns@icloud.com
Inspection Request Date: 2026-06-11
Inspection Type: Full System
Comment\ Notes: ON THE CORNER OF PARKWAY AND WOODLANE
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
MASON COUNTY
Public Health & Human Services
FINAL INSPECTION:
SWG2025-00460
ADDRESS: 231 E Wood Ln
PARCEL: 320215502022
DATE: 6/12/202(p
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HOUSE TO DRAINFIELD
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