HomeMy WebLinkAboutSWG2025-00166 - SWG As-Built - 7/23/2026 Docusign Envelope ID: 940C18AE-4967-8203-803D-266CF8940788
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00166 Parcel #320241290003
Applicant Name I n8an wear Subdivision (Name/Div/Block/Lot)
Applicant Address 2000 W Shelton Valley Rd TR 3 OF SP#2539
City, State, Zip Shelton Wa 98584 Installer Name Logan Spear
Site Address Designer Name Micah Halverson
INSTALLATION CHECKLIST
❑ Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type Standard Shallnw Pressure Trench Pretreatment Type Septic Tank
>5 ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - - N/A YES NO
>50ft. fromwells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ Cx ❑
>50ft. fromsurfacewater? - - - - - - - ;- - - - - - - - ❑ [ ❑
H Cleanout between building and tank? -/�' -��'���-'r_L - Q ❑ ❑
U Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ [1 ❑
a 24" access risers over each compartment?- - - - - - - - - - - - - - - -
❑ [ ❑
tW Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ fl ❑
)
Septic tank capacity (working) 1200 gal Manufacturer Sound Placement
C D-box water level and speed levelers used? - - - - - - - - - ❑ N/A ❑ YES [ No
0O Manifold/D-box accessible from surface?- - - - - - - - - - - ❑ ❑
QQCheck valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ Q ❑
2 Transport Line Size 2', Schedule/Class 40
Bedrooms installed (check one) ❑ 2 [I 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ® YES ❑ NO
>100ft. fromwells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑
W >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑
ti >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑
Q > 5ft. from property linesand easements?- - - - - - - - - - - - - - - - ❑ ® ❑
W > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ L1 ❑
Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑
❑ 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) 1200 gal Manufacturer Sound Placement
Z
Q 24" access riser(s) and accessible from surface?- - - - - - - - - - - - - ❑ ® ❑
Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - -
❑ ❑
Control Panel equipped with Timer/ ETM / Counter - - - - - - - - - - ❑ EI ❑
a Pump installed in Q Bucket or ❑ On Block or ❑ Other
a Pump Make/Model I iherty Fl 51 Floats or ❑ Transducer
Tank draw down 1 75 in/min Pump capacity 43 gpm Squirt Height 30" ft
Pump on time 11 min Pump off time 4 hrs Daily flow set at n gpd
Undated 8/21/2018
Docusign Envelope ID: 940C18AE-4967-8203-803D-266CF8940788
Mason County OSS Installation Report pg. 2 Parcel# 320241290003
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - - - 5 YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - - - 5 YES 5 NO
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,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits
® 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
f gpgyattached Record Drawing is accurate. form and attached Record Drawing is accurate.
CDC Pt 4
Signature of Installer Date
gan Sper t\1
Printed Name of Signee �\
MASON COUNTY PUBLIC HEALTH : g
The undersignedDrawin approves t tionhis Installa Report and ato0�o6
g
Record on behalf of Mason Count Public i�Gwta�Nt�n y lJCeMlD O81sl�t
Health:
Signature of Environme tal Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21!2018
MASON COUNTY
Public Health & Human Services
FINAL INSPECTION:
SWG2025-00166
ADDRESS: XXX E Agate Rd
PARCEL: 320241290003
DATE: 5/4/2026
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HOUSE TO DRAINFIELD
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ter"
DRAINFIELD TO HOUSE
Docusign Envelope ID:940C18AE-4967-8203-803D-266CF8940788
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' 1)4"ASTM 3034 Future Connection O
u� 2) 1200 Gallon 2 Compartment Septic Tank —J ao 0
N ���EN\�RpNMEN1ALNEAI-TH 3) 1200 Gallon Pump Chamber
AS0 CQ
4) Rhombus Control Panel rn o
RE\ 5) Preferred Manifold Location p) c� o
6)2" Sch40 Effluent Transport Line '� 0
7) Observation Ports/Sweep Access Q) C
This end of each Trench
Property lines Established By Other
306 +I________________________ O
This is not a survel`: ' �
This Asbuilt Drawing is intended for the purpose of 30' 0' 15' 35' 60 > X locating and maintaining the septic system on this parcel. > O ;
Measurements and distances are approximate.
It is advised by septic designer Micah Halverson O >
to use a licensed surveyor to determine lot lines, Scale 1 =30' —
elevations,topography and to provide a legal site plan.
Owner Is responsible for establishing all property lines,
easements and/or right-of-ways.
Inspection Dat •1/14/ 02h