HomeMy WebLinkAboutSWG2025-00391 - SWG As-Built - 7/22/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG,.Z0,25— 0 p3 f__— Parcel #_
Applicant Name Geer �D"'�S L� Subdivision (Name/Div/Block/Lot)
Applicant Address
City, State, Zip �0 ! 7v Installer Name
Site Address J1 9V A�9V Or Designer Name � l� ►�1
INSTALLATION CHECKLIST
Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other_
System Type PJ r' Pretreatment Type /iCt. W4 f'
>5 ft. from foundation? - JJ- - - - - - �} Li N/A YES ❑ NO
>50ft. fromwells? - - - - - - - - - - - - __ _____ _ _ _ _ ❑ ❑
>50 ft from surface water? - - - - - -
- - - - _ _0 8 82fi_ _ ❑ ❑
Cleanout between building and tank? - -- - - - --- ❑ ❑
o Tank baffles present? - - - - - - - - By- - - - _ _ - - _ - ❑ ❑
0. 24"access risers over each corn part -:- _--_----_ _ ❑ ❑
W Effluent filter installed?- -- - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ ❑
Septic tank capacity (working) &N9 `-OO gal Manufacturer Y Cl//n4M / I -t!u Y
a D-box water level and speed levelers used? - - - - - - -- - - -- - - NIA Li
❑ No
DO Manifoid/D-box accessible from surface? - - - - - - - - - - --- -- .. ❑/ ❑
mz Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - _- ' ❑ ❑
Q<
2 Transport Line Size I Schedule/Class YO
Bedrooms installed (check one) ❑ 2 3 ❑4 ❑ 5 ❑6 ❑Commercial/OtF}er
>10ft.fromfoundation?- - - - - - - - - - - - - - - - - - - - - - - - -- ❑ N/A YES ❑ No
>100 ft.from wells?- - - - - - - - - - - - - - -- - - - - -- - - - - - - - ❑ Pf ❑
>100ft. fromsurfacewater? - - - - - - - - - -- - - - - - - - - - - - -- ❑ ❑
W
u. >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - -- - ❑ ❑
Z > 5 ft. from property lines and easements?- - - - - - - - - - - - - - -- ❑
❑
> 30 ft.from downgradient curtain/foundation drains? - - - - - - - - --
Drainfield level and observation ports present - - - - - - - - - - - - -- [� ❑
Graveless chambers or ❑ Clean gravel used? (check one) /
Proper cover installed over drainfield?- - -- - - - - - - - - - - - - -- - ❑ tYl ❑
Pump tank setbacks consistent with septic tank? - - - - - - - -- - - -- ❑ N/A YES ❑ NO
`.L Pump tank capacity(flood)Jgal Manufacturer b e(M4/1 Biel— St
Z ---
Q 24"access riser(s)and accessible from surface?-- - - - - -- - - -- - ❑ ❑
aAlarm or Control Panel Installed? - - - - - - - -- - - - - - - - - - - - - .- ❑ ❑
= Control Panel equippe with Timer/ETM /Counter- - - - - - - - - - - ❑ 121" ❑
Pump installed In (Bucket or ❑ On Block or ❑ Other
Pump Make/Model pteO PP ZP45 [ ' loats or ❑ Transducer
Tank draw down /✓ in/min Pump capacity_- ,,.gpm Squirt Height tit'
Pump on time ? flh'n Pump off time táØ t1 hf` Daily flow set at
UDtlu lwl 8l111T01
Mason County OSS Installation Report pg. 2 Parcel It _,2..70 I aS000.207
ABANDONMENT RECORD
\Nero existing septic components abandoned as part of this project?
I�r- - - - - - - - - - - - - - YES NO
If yes. please describe: e/CtS ?+ SeP�t'G nf�I�m _I ' L wf eQ Bf .ye)
Wore all components pumped out and properly abandoned per WAC246-272A-0300? - — — — — - — - ES NO
RECORD DRAWING
This Is a permanent record and must be accurntn and descriptive enough to re•locnto In the nand of maintenance neltvlllea and future development. Typical Record
D' .ngs conta•n Dramttold 6 manifold orientation 8 layout.Septic/pump lank location,North arrow.reserve drninaold,existing and proposod buildings,location of wells,walerllnea,
wens obsorvat,on ports.clonnouts and other maintenance access points. incomplete Record Drawntgs may croato oddiUonal doleye in tnnl Installation approval and rotated pormila.
(,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 an attached Record Drawin is accurate. form and attached Record Drawi is accurate.
Signature of Installer Date .
Ii J
Scott- �ohnfon
Printed Name of Signee ' ;, j
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and �' 5IUd4i2 fi%
�• ADAM J.HUNTER
Record Drawing on behalf of Ma on Coun bile
ty ,y 4L ('271"7ótZ6 Health: gSDN �U�
c°�Nry
Signature of Environmental Health Specialist Data (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated entnota
Kayla Milam
From:
Sent: DO NOT REPLY <norcply )rnasoncouritywa,gov>
To: Tuesday,June 9, 2026 8:49 AM
Subject: Environmentalhealth
OSS Inspection request for Cezar Flumes LLC - 5wg2025-00391
Submittal request for: Cezar Homes LLC ---
Site Address: 151 e agate dr shelton wa 98584
Permit Number:Swg2025-00391 JUN 0 9 2026
Parcel Number: 220185000207
Installer Name: Scott Johnson
Installer Phone Number:3604905408
Installer Email Address:affordablesepticpnw@gmail.com
Designer Name: Adam hunter
Designer Email Address:jhandassociates@hotmail.com
Inspection Request Date:2026-06-09
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.
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SCALE-1"=20'-0"
SLIGHT DEPRESSION(FILLED WITH ASTM C33 SAND)
60'-1"SCH40 SUPPLY/RETURN LINES
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x $ PROPOSED HEADWORKS(SEE DETAIL PG 2) c
00GAL.PUMP CHAMBER
SOLD D FIELD NDONED)
OSCAR II R/A/ / 0
PTIC TANK( ANDONED PER CODE)
13.
/ \ woter
15 �STUBOUT/CLEANO \\ wa
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3 BDRM RES
NUWATER BNR500 ATU IN APP VED SEPTIC TANK
EXISTING DRIVE
PRESSURE TEST COMPLETED BY INSTALLER
SQUIRT HT: !11I OAP
,x Q�
DRAWDOWN:IJ/p t2 '
TIMER SETTINGS -
ON:
OFF: j. HfLs
JIM HUNTER & ASSOC. CONTRACTOR
M All P.O. BOX 162, OLY, WA 98507 AFFORDABLE SEPTIC
AS�N��U ' 22026 753-1226
Nry JHANDASS0CIATES@H0TMAIL.00M INSTALL DATE- 6/9/26
Q✓�Q yM�yTAC H RECORD DRAWING SITE ADDRESS/LEGAL
�Tf1 151 E AGATE DR
OWNER - CEZARNOWOWIEJSKI
FINAL DATE- 6/15/26
TP# 22018-50-00207 SITE # SWG2025-00391