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HomeMy WebLinkAboutSWG2025-00422 - SWG As-Built - 7/29/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH Permit Number SWG 2025-00422 Parcel# 32123-31-00000 Applicant Name Justin and Samantha P, gsdale Subdivision (Name/Div/Block/Lot) Applicant Address 3911 E Mason Lk Rd City, State, Zip Shelton,WA 9858 Installer Name Tony Robinson Site Address 3911 E Mason Lk Rd Designer Name Rod Left Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type a 4 Pretreatment Type______________________- - ' din � yp >5ft.fromfoundation? ---------j- - ----------- - - ❑ NiA DYES NO =g U � >50ft. fromwells? ---- - - - --- - - - ❑ © ❑ - >50ft.fromsurfacewater? - - - - - - --41F ❑ ❑■ ❑ Cleanout between building and tank? -JLJL-t-L 20-2 -- V -- ❑ UI ❑ Tank baffles present? - - - - --- - - - - --- - -- -- - - - - ❑ II 24" access risers over each compartm - - - - - - --- - - ❑ ❑■ ❑ CEffluentfilterinstalled?- --- - ---- --- - --- - - - -- -- -- - - ❑ ❑ 0 z ; -= Septic tank size 1500 gal Manufacturer 1400e.c tAo'n =rte D-box water level and speed levelers used? - --- ----- - -- - -- 0 N/A ❑YES ❑ NO f3 Manifold/D-box accessible from surface?- - - --- - ---- -- - --- ❑ ® ❑ Check valves installed? - - - - - -- -- -- - --- ---- - -- - --- ❑ 0 ❑ Transport Line Size 2" Schedule/Class Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation? -- - --- -- - - - - -- - - - -- - -- -- - ❑ N/A DYES ❑ NO >100ft.fromwells?------------- - - - --- - ----- --- - ❑ 0 ❑ >100ft. from surfacewater? -- - - - -- - - -- ------ ---- -- - ❑ 0 ❑ >10ft.frompotablewaterlines?---- -- -- --- --- - - --- --- ❑ ❑■ ❑ >5ft.from property lines and easements?-- - - -- - - - - -- - -- - ❑ UI ❑ > 30 ft from downgradient curtain/foundation drains? --- -- - - --- II ❑ ❑ Drainfield level and observation ports present -- - -- ----- - -- - O © ❑ J Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfleld?------------- - - ---- ❑ II ❑ Pump septic ❑ N/A 0 YES ❑ NO tank setbacks consistant with tank?------------- Pump tank size 1500 gal Manufacturer Hagerman Precast 1124"access riser(s)and accessible from surface'?------- - -- - -- O Yofarmor ane ? - Alarm --- ----- - ---- --- - - - - ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - O II ❑ Pump installed in O Bucket or ❑ On Block or ❑ Other Pump Make/Model Liberty 290 I Floats or O Transducer Tank draw down 1.5 in/min Pump capacity f gpm Squirt Height +6 ft R Pump on time i Pump off time 3HR Daily flow set at 3 b(7 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 32123-31-00000 9�� Yom, Were existing septic components abandoned as part of this project? --------------- ❑ YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- ❑ YES 0 NO This Is a permanent record and must be accurate and descrtptivo enough to re-locate In tho need of maintenance activities and future development. •typical Record Drawings contain: Drainfleld&manifold orientation&layout,Septidpump tank location.North arrow,reserve drainfleld,existing and proposed buildings,location of walls,waterline.. wells,observatlan ports,cleanouta,and other maintenance access points. Incomplete Record Drawings may create additional delays In Mel Installation approval and related permits. Ii F Record Drawing Attached t t 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 II I further certify that all information contained on this I further certify that a!!information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing Is accurate. -qtr Signet of Installer Date To yJi cç r o ij Printed Name of Signee w , MASON COUNTY PUBLIC HEALTH 44 p, - The undersigned approves this Installation Reporfan ( rya P toot Record Drawing on behalf of Mason County Public c3ci E DE-8113NER Health: A/Z EXPIRE/\ S 121951 ?('? MIAs ?9 026 Zo Z �O�"ryFN Signature of Environmental Health Specialist Date OJq M 'TA(h (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 812112018 . r 1100. 00 ��su • r::_t: I• ••I am• .,'.'••. I Q / / / /7 /9 \ ( ,- / AC(�v S' . _..' _ ••f•. N ) , he 4y7::"„• i U)> \ n r� 14[R MASON 2026 JUL 29 COUNTY ENVIRONMENTAL HEALTH EALTH RECORD OF CONSTRUCTION o 5,� 30 50' 75' THIS IS NOT A SURVEY. ALL PROPERTY LINES/BOUNDARIES HAVE SCALE(FEET) BEEN DEMONSTRATED BY THE OWNER(S) AND/OR THEIR AGENT(S). LEGEND �' = SOIL LOG ACm` mE D E S I C N *ALL MEASUREMENTS WERE TAKEN FROM KNOWN POINTS DEMONSTRATED BY THE PROPERTY OWNER. --- = NO BUILD ZONE - =CLEARING LIMITS DATE- 13 FEB 2026 *ALL MEASUREMENTS WERE TAKEN WITH AN OPEN-REEL FIBERGLASS TAPE MEASURE. =LOWAREAs P.O. BOX 2954 * NO FOUNDATION SPOILS OR BURNING ON DRAINFIELD AREAS. -,` TREES- 12•• DIA NAME- RAGSDALE SILVERDALE, WA. * DUE TO UNFORESEEN WATER TABLES, A CURTAIN DRAIN MAY BE REQUIRED. = CLEAN OUT TAX ID- 32123-31-00000 98383 * DIRECT ALL DOWNSPOUT/SURFACE WATER AWAY FROM DRAINFIELD AREAS. =1500-GAL SEPTIC TANK * ® =1500-GAL PUMP TANK STREET- 3911E MASON LAKE RD TEL. 360-698-8488 ALL TANK ACCESS COVERS ARE RISERED TO FINISHED GRADE. INFO@4CMESEPTIC.COM =SPLITTER SCALE: 1"=50' ROC ACME DESIGN ° DATE- 13 FEB 2026 P.O.BOX 2954 NAME- RAGSDALE SILVERDALE,WA. TAX ID- 32123-31-00000 98363 STREET- 3911 E MASON LAKE RD TEL.360.698-8488 INFO a�1 CMESEPAC.00M NOT TO SCALE ROC 1800.00' COON 2 �ASpN n E 9 2026 $H° ®JQ NT AL at, CREEK O� • r.,.. . t 250.00' L•� tt � i-i•• ' �.li:.V.. `1. t'�r ..t.S.i"�Ar'� j 4Y 2 h � ').. Ti... _ � elf t� 5'a.i+.7n���- _ y �` ` _ _ _ Q �•i..ti...f,.i 5 7a..'K• .vt:- -»_"�C:'.. ��'-••.).• ..ai,,..-a �7li 1...n _.f. �].n l..-,� vey... _ i _ __ �.ro� ..r.i �)!•s,. .-rr .r >..�', � .a •ru=.atg, .A.. '-"' .,ti�'x•iiu:. { trio-f!i4 "z c'..j`V <v t.. _.r A:r,l:< ! :.:�'•�. P ��y c§'y 2n �F3 LICENS eSIQNER C:YPiR%S �1��a6