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HomeMy WebLinkAboutSWG2026-00111 - SWG As-Built - 7/13/2026 c r Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00111 Parcel# 22202-52-00008 Applicant Name Brian & Christel Lowney Subdivision (Name/Div/Block/Lot) Applicant Address 6820 76th St Ct E Pleasant Cove Beach Tracts City, State, Zip Puyallup, WA 98371 Installer Name Arrow Excavating Site Address 4710 NE North Shore Rd, Belfair Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other System Type OSCAR XO2 Pretreatment Type XO2 >5 ft. from foundation? - - - -- - - - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - - - - - - - I E-U7 _ - ❑ UI ❑ Z >50ft.fromsurfacewater? - - - - - - - - - - - - - - - - - - - ❑ ❑■ ❑ Cleanout between building and tank. - JUL-�-�- 2026- - - ❑ ■❑ ❑ V Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ■❑ ❑ a 24" access risers over each comps runt?-- - - - -- - - -- - - - ❑ LU ❑ W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑■ Septic tank capacity (working) 1,060 gal Manufacturer Infiltrator Z-C.&M D D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A ❑ YES 0 NO a0Manifold/D-box accessible from surface? - - - - ❑ ■❑ ❑ £ 2 Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ 0 �d 2 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ❑■ YES ❑ NO © >100ft. fromwells?- - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ LU ❑ W >100 ft. from surface water? - - X- - - - - - - - - - - - ❑ ❑ ❑ U: >10ft.frompotablewaterlines?- - - - -- - - - - - - - - - - - - - - - - ❑ 0 ❑ Z - > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ Iii ❑ d- f > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ UI ❑ Proper cover installed over drainfield? - - - - - - - -- - - - - - - - - - ❑ M ❑ Pump tank setbacks consistent with septic tank? -- - - - - - - - - - -- ❑ N/A 0 YES ❑ NO Pump tank capacity (flood) 1,060 gal Manufacturer Infiltrator 2- e�'°^�• . 24"access riser(s) and accessible from surface?- - - - - - - - - - - - - ❑ Q Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ UI ❑ Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - ❑ © ❑ d. Pump installed in ❑ Bucket or ❑ On Block or ® Other on bottom of tank Pump Make/Model AY McDonald E-30, ,115v30gpm,1/2hp ❑■ Floats or ❑ Transducer EL Tank draw down -- in/mm Pump capacity 6.2 gpm Squirt Height -- ft Pump on time 30 sec Pump off time 3 min Daily flow set at 360 gpd Updated 8/21/2018 Parcel# �rj,2D2 52- - oaoo8 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - --- - - - -- - - - - - YES NO If yes, please describe: NO Were all components pumped out and properly abandoned per WAC246-272A-0300? ---- - -- - ® YES 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,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. eQ ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I 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 that all information contained on this I further certify that all information contained on this form ar ttached R ord Drawi s.accuratee. form and attached Record Drawing is accurate. nature of installer Date clan\ C-7:x s-�ra�-4 Printed Name of Signee S wne MASON COUNTY PUBLIC HEALTH The undersigned approves this installation Report and Record Drawing on behalf of Mason County Public . ?' 5100349 f 1 PAULA JOY JOHNSON '. Health: ts; l Eli ESi N141 Signature of Environmental alth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 612112015 tcp � . CLE : p 35 3c 45 60 • As- eL moo. �3z2�i4N- C}4P,i5-rEL Lowt'J EY ____ _____ a2 PAULA JOY OHNSO 0 1\i E- N C f'`j <'t' .C g O iCK�(S�fi S! n sue 1-(3\ asp 5Et_Ftt R ' As PEf Rbi ti vJ o3l611 ___ - / 1` O -!2 GSt_, Let - N D :J Fxt s-C. z- o— 14:: GS L; 14 41 o GAC�RG� �s�,2�ctU �- Spy ® F co�`tQ�kc-Tlbt�t ° o — �4"E&L.CS Tb 6o i-1 N t0` F�isTts`U ��" t 57 U Th : ITi \2c ,1, �, Key. OControl Panel with Audio-Visual Alarm bet -basUU c �vr O Cleanout �� R� O 1,00 Gallon Septic/Aeration Tank Rp Pt) (DO ' N )( Std 2-Compartment with air diffuser O1,060 Gallon Clarifier/Pump Tank____ _____I2-Compartment 7 n �J Headworks 10' x ! ' x 7(0 ' O OSCAR XO2 Mound Drainfield /�.�V_ o t d -F k ins bp�.r • aQce s;Cr.cd JUL 2 8 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2026-00111 ADDRESS: 4710 NE North Shore Rd PARCEL: 222025200008 DATE: 6/22/2026 - =s `y py .Xr �" -•era.-,:" HOUSE TO DRAINFIELD r r 1'6. IN' SY�lJ21`"3bY DRAINFIELD TO HOUSE bavid Anderson From:Sent: DO NOT REPLY <noreply@masoncountywag. ov> To; Thursday, June 18, 2026 3:10 PM Environmentalhealth Subject: OSS Inspection request for Brian lowney - 2026-00111 Submittal request for: Brian lowney Site Address: 4710 NE North shore Rd. Permit Number: 2026-00111 Parcel Number: 222025200008 Installer Name: Arrow excavating Installer Phone Number: 3604906410 Installer Email Address: arrowexcavating@outlook.com Designer Name: paula johnson Designer Email Address: paulaj@hctc.com Inspection Request Date: 2026-03-18 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. 1