Loading...
HomeMy WebLinkAboutSWG2026-00076 - SWG As-Built - 7/10/2026 1 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00076 Parcel# 32005-23-90046 Applicant Name Robert& Kristy Rutledge Subdivision (Name/Div/Block/Lot) Applicant Address 541 E Meyer Lake Rd City, State, Zip Shelton, WA 98584 Installer Name County Line Development, LLC Site Address 543 E Meyer Lake Dr, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Sand-Lined Pressure Bed Pretreatment Type >5 ft, from foundation? - - - --- - - - - - - - - - - - - - - - - - - ❑ NIA *YES NO >50ft. fromwells? - - - - - - - - - - - - �V_yg ❑ ❑� ❑ >50ft.from surface water? -- - - - - - U ❑ ❑ HZ � -1-Z0Z6 - N Cleanout between building and tank? - - - - - - ❑ 0 ❑ t� - - -- - - - - - - - - ❑ ❑■ ❑ Tank baffles present? - f 24" access risers over each compartme - - - - - -- - ❑ ❑I ❑ LU Effluent filter installed?- - - - - - - - - - y - - - - - - - ❑ ❑� ❑ Cl) Septic tank capacity (working) 1,250 gal Manufacturer Infiltrator C D-box water level and speed levelers used? - - - - - - - - - - - - -- - ❑ N/A ❑ YES ❑■ NO X0O Manifold/D-box accessible from surface?- - - - - - -- - - - - - - - - - ❑ ❑ UI cnZ" Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ UI ❑ ❑a Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 UI 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ■❑ YES ❑ NO 0- >100ft. fromwelIs?- -- - - - - - - -- - - - - - - - - - - - - - - - - - - ❑ ■❑ ❑ W >100ft. fromsurfacewater? - - - - - - - - - - - - - - - -- - - - - - - - ❑ F ❑ T_ >10ft.frompotablewaterlines?- - - - -- - - - - - - - - - - - - - - - - ❑ ❑■ ❑ Q > 5ft.frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ UI ❑ W > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ UI ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- -- - - - - - -- - - - - - - - - - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank?-- ---- - - - - - -- ❑ N/A • YES ❑ NO Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator Q 24" access riser(s) and accessible from surface?- - -- - - - - - - - - - 0 © ❑ CL Alarm or Control Panel Installed? - - - - - - - - - - - - - - - -- - - - - - ❑ © ❑ Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - ❑ © ❑ CL Pump installed in ■❑ Bucket or ❑ On Block or ❑ Other a' Pump Make/Model Zoeller N152 Q Floats or ❑ Transducer Tank draw down 2.25 in/min Pump capacity 56 gpm Squirt Height 5 ft Pump on time 1.6 min Pump off time 6 hr Daily flow set at 360 gpd Updated 8212018 Mason County OSS Installation Report pg. 2 Parcel# 3Z�o5 2- b —� O6 (p ABANDONMENT RECORD ------ NO ffW:ereexisting septic components abandoned as part ofthis protect? - YES please describe: Were all components pumped out and property abandoned per WAC246-272A-x300? --- - O YES ❑ NO RECORD DRAWING arrough to tin the need of rnairrirxrsr+u a vrtfes and future de crrt TyPiral Recall This is a pammrent record and must be accurate artd desuiptive bold location of wells,waterlines, Drawings contain: Drasnfiefd&manifold aientzJon 3 layer.SePddpurP tank k)cation,North avow,reserve drain5eld,existing and Proposed n9s• weds,obseriav ports.deanouts and oilier rzea renance access Pte. incomplete Rem Drawings nay asats adthionat decoys in final insiallaizm aQptwai and related-emote. 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 clearedlapproved by both the designer shown here have been clearedlapproved 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 fu e rtify that all information contained on this I further certify that all information contained on this f0 attached Record Dra>I►ring is accurate. form and attached Record Drawing is accurate. r Signature of Installer Date MICHAEL LOVELY Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and �r Record Drawing on behalf of Mason County Public PAULA JOY JOHNSON '. Health: � Signature of Environmental eatihh Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upda1°d 8!21!2018 0°`�SLaP E / 1 / I I / , i,I/,I/ /D PH 1�1T * t t�5 t ?.L E- / J/ NtF . oT W - t�ADlV 5ES i BEr-o1E Dt(GIr1U" I Ii tiE /s R��°E He =�ti / 9 it — -- - M 1 � I / / / l�V �v / 4p / i) f 3- a 24 t7 G L S+ *EA1 c 2 [5 l Z7�t=&` t) 42P b 25 SD "!s ;OO ems S Auclio-Visua?.Alarm -r-t-K R. S-rN t3TLEOC Cleanout Q( LFiL JZfl6S-23Ract)4( O t 2 Sn gallon Septic Tank 64S S MeV sc2 cAi=E. -Com�an�ent with s�}-S L-ro VCA a Sid fluent Ater 1000 Callon Pump Chamber '� • **Note to installer** APPROVES :��� Sleeve waterline when within 10' JUL 28 2026 ..���� of septic transport line. Maintain 10' minimum between water MASON COUNTY ENVIRONMENTAL HEALTH ` PAULA JOY JOHNSON .\ line and septic tanks/drainfield. RET 1 Ito-1�co !a Mi�m Sttti� DO NOT REPLY <noreply@masoncountywa.gov> Tq Saturday, July 11, 20267:59 AM Su)yt Environmentalhealth OSS Inspection request for michael lovely - SWG2026-00076 Submittal request for: michael lovely Site Address: 543 meyer lake rd Permit Number:SWG2026-00076 Parcel Number: 320052390046 Insta<iiler Name: michael lovely Installer Phone Number: 3602920909 Dr'J Installer Email Address: MIKE@COUNTYLINEDEVELOPMENTLLC.COM } 2( By Designer Name: paula johnson --- I Designer Email Address: paulaj@hctc.com Inspection Request Date: 2026-07-13 Inspection Type: Full System Comment\ Notes: if little white dog is out he is super friendly. inspection ports for end of laterals placed at the end of the drainfield and will be properly installed during backfill. 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. JL • ' � ' �� •III . s sue, M k'� �°+• r� d tilt ^..�� z, w ti. � 9 ✓Yf i A F s ice.