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HomeMy WebLinkAboutSWG2025-00167 - 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 2025-00167 Parcel # 320241290002 Applicant Name ��gan c�par Subdivision (Name/Div/Block/Lot) Applicant Address ?nnn W Shcltnn Valley Rd TR 2 OF SP #25g 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 St d.,rd Sh-.ltnw Presstire Trennh Pretreatment TypeSeptin Tank >5 ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A YES LINO >50 ft. from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ Z >50ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ < Cleanout between building and tank? -,VQ-S�r� Jri _ _ _ _ _ ® ❑ ❑ U Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ F- 24" access risers over each compartment?- - - - - - - - - - - - - - - - ❑ ❑ WEffluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ Septic tank capacity (working) 1.200 gal Manufacturer Sound Placement O D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A ❑ YES ® NO p0 Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - - ❑ LI mZ Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ OQ Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ® 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ® YES NO >100ft. fromwells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ W 1 >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ ? > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ ® ❑ X > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ x❑ ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfietd?- - - - - - - - - - - - - - - - - - - ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ❑ N/A ® YES ❑ No Y Pump tank capacity (flood) 12gggal Manufacturer Snuind Placement Q24" access riser(s) and accessible from surface?- - - - - - - - - - - - - ❑ © ❑ F- Alarm or Control Panel Installed. ❑ a 2 Control Panel equipped with Timer/ ETM / Counter ❑ O ❑ O Pump installed in nx Bucket or ❑ On Block or ❑ Other Pump Make/Model I mhartv Fl 51 Floats or ❑ Transducer Tank draw down 1 75 in/min Pump capacity 43 gpm Squirt Height so" ft Pump on time 1 1 min Pump off time 4 hrs Daily flow set at 1hn gpd Updated 8121!2018 Docusign Envelope ID: 940C18AE-4967-8203-803D-266CF8940788 Mason County OSS Installation Report pg. 2 Parcel # 320241290002 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - - - YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - - - ❑ YES 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 g gyattached Record Drawing is accurate. form and attached Record Drawing is accurate. sft AY Signature of Installer Date Printed Name of Signee �� MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and ' \ - Record Drawing on behalf of Mason County Public 5100M 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 k91's. FINAL INSPECTION: SWG2025-00167 ADDRESS: XXX E Agate Rd PARCEL: 320241290002 DATE: 5/4/2026 1111111 • 1 4� F TY� Y HOUSE TO DRAINFIELD F �S F `a Y.. DRAINFIELD TO HOUSE Docusign Envelope ID: 940C18AE-4967-8203-803D-266CF8940788 NEW 3 BEDROOM ON-SITE WASTEWATER ASBUILT T SW G2025-00167 -00167 U z rV) Z N I \ W W W � N \ O O \ O - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Callouts N M LO 1)4"ASTM 3034 Future Connection N Cq 2) 1200 Gallon 2 Compartment Septic Tank o Il 3) 1200 Gal Pump Chamber M CO Emily Lane 4) Rhombus Control Panel - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - � — - 5)2" Sch40 Effluent Transport Line a� - - - - - - - - - - - - - - - - - - - — V0 4 rE 41 6) Manifold Access E C1 Driveway 6� 15 7) Observation Port/Sweep Access R�'O en "Ge �n n n This end of each trench II II II I I Slope A FI 1 cr) 1111111 I II II III I C (4r' 1111111 Io / LU ->' J 1 3 ) S •. Lat2 CD 15A - _ — -- 2 O APPROVED 1` JUL. 2 9 2026 ' 1 V 1ao MASON COUNTY ENRONYIEVAL HEALTH -initial }7TM � RET IC UCO'MOE M • This is not a surveu: : o) )P � This Asbuilt Drawing is intended for the purpose of 0 locating and maintaining the septic system on this parcel. Property lines Established By Othe Measurements and distances are approximate. ttD It is advised by septic designer Micah Halverson > x to use a licensed surveyor to determine lot lines, o 306'+1 elevations,topography and to provide a legal site plan. m 30' o' 15' 35' 50'Owner is responsible for establishing all property lines, = 0 easements and/or right-of-ways. Scale 1 30' Inspection Date: 111412026