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HomeMy WebLinkAboutSWG2026-00155-ASBUILT - SWG As-Built - 6/29/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00155 Parcel # 422055000901 Applicant Name Adam Hunter Subdivision (Name/Div/Block/Lot) Applicant Address 2201 93rd Ave SW City, State, Zip Olympia, WA 98512 Installer Name Brandon Thompson Site Address 241 N Deer Lane West, Hoodsport Designer Name Adam Hunter INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only • Repair ❑Other System Type Standard PSI System Pretreatment Type NA >5ft. fromfoundation? - - - - - - - --- - - - -- - - - ---- - - - -- ❑ N/A • YES NO >50ft. fromwells? - - - - - - - - - --- _` - ❑ ® ❑ Z >50 ft. from surface water? - - - - - _�{,-Imo, -'u- - - ❑ ❑■ ❑ Cleanout between building and tank t.\ . - -- - - - - - - - ❑ ❑ - 2 ?�26- -' - ❑ 0 ❑ d24" access risers over each compart ent?- - - -- -- - - - - ❑ ® ❑ W Effluent filter installed?- - - - - - - -\-B . - J Septic tank capacity (working) 1060 gal Manufacturer INFILTRATOR 13 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A 0 YES ❑ NO pO Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - - ❑ Lii ❑ 1:9 Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ [1] ❑ Transport Line Size 2 INCH Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ N/A YES ❑ No >100ft. fromwells?- - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ U ❑ >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑■ ❑ W T- >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ Q ❑ Q > 5ft.frompropertylinesandeasements?- - - - - - - - - - - - - - -- ❑ ® ❑ O > 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?- - - - - - - - - - - - - - - - - -- ❑ II ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ❑ N/A © YES ❑ NO Pump tank capacity (flood) 1060 gal Manufacturer INFILTRATOR Q24" access riser(s)and accessible from surface?- - - - - - - - - - - -- ❑ ® ❑ F- Alarm or Control Panel Installed. ❑ ® ❑ Control Panel equipped with Timer/ ETM /Counter - - - - - - - - - - ❑ ® ❑ Pump installed in ❑ Bucket or ® On Block or ❑ Other d Pump Make/Model LIBERTY/ LE41 M _ 24 ® Floats or ❑ Transducer Tank draw down 1 INCH in/min Pump capacity 128M42 gpm Squirt Height 36" ft Pump on time 1 MIN 40 SEC Pump off time 4 HOURS Daily flow set at_________ Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 422055000901 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - -- Q YES NO If yes. please describe:EXISTING DF & SEPTIC TANK ABANDONED PER CODE 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 draintield,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. PRecord 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 d a ched Re rd Drawing is accurate. form and attached Record Drawing is accurate. 6/24/2026 Sign ture of Ins ler Date BRANDON THOMPSON Printed Name of Signee I29I2 MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and 'rY Record Drawing on behalf of Mason County Public y .wu eD.r•IJ HUNTER Health: 1..,:.,.;t h .•�r• _ �n^n ( ��.. ,•...,,u�zx�26 Signature of Environmen al Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121/2018 DO NOT REPLY <noreply@masoncountywa.gov> I " Monday, June 22, 2026 8:20 AM Envir0nniantalhealth lest OSS Inspectlon request for Jon Girsch - 5WG2026-00155 Submittal request for,Jot)Girsch Site Address:241 N Deer LN W I U\\I JCS V Permlt Number:SWG2026-00155 Parcel Number:422055000901 Installer Name: Bay Shore Construction Installer Phone Number:360-528-1643 By Installer Email Address:todd@bayshoreconstructionoly.com Designer Name:Adam Hunter (0� Designer Email Address: adam.j.hunter@gmait.com Inspection Request Date:2026-06-22 Inspection Type: Full System Comment\Notes: NOBODY LIVES IN THE HOME. ELECTRICAL INSTALL THIS WEEK. 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. 1 •} MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2026-00155 ADDRESS: 241 N Deer Lane W PARCEL: 422055000901 DATE: 6/23/2026 f / �.1� � y ^�.rt`t.1 ..(yam■♦/ •"4rJC:• �V :'• �r•Y 5 w iT1� HOUSE TO DRAINFIELD IN ! ' �C r k .. • • - DRAINFIELD TO HOUSE SCALE: 1" = 20FT 100 FT TO OHWM 200.0 1 \ \ 12 \ \ \ ACCESS/UTILITY ES T \ \ DECK 4 7- 3 \ \ \ 4"PVC GHTLINE(CR+ISHPROOF SLEEVE ACROSS DRIVE) 90.0 , \\ 90.0 9 \ \ \ \ 6 11 g R/A \ \ 24.0 O 24.0 \ \� \ \ \ \ \ b b \ 10.0 10.0 \ LAKE CUSHN 200.0 \ PRESSURE TEST COMPLETED BY INSTALLER: SQUIRT HEIGHT: OEXISTING 2 BDRM RES DRAWDOWN: EXISTING WATERLINE TIMER SETTINGS- ON: EXISTING DRIVE A n O� OFF: r p EXISTING STUBOUT/ADD CLEANOUT(IE.-98.5) E \ ABANDONED SEPTIC TANK(PER CODE) JUL 1 0 2026 EPTIC TANK MASON COUNTY ENI 7RON,ME PUMP CHAMBER RET htA�HEALTH SO 2"PVC TIGHTLINE(SCH40) I 10FTX24FT DRAINFIELD AND RESERVE AREA HUNTER SEPTIC DESIGN CONTRACTOR: 2201 93rd Ave SW,Ste A/Olympia,WA 98512 BAYSHORE 11 FAILED D.F(DUE TO ROOTS AND AGE)-ABANDON �29 360-890-2778/adam@huntersepticdesign.com INSTALL DATE: 6/25/26 `•. SITE ADDRESS/LEGAL: 12 RBM IS GROUND EL.@ HOUSE CORNER(RBM=100.0) ; f•:.y, RECORD DRAWING FOR: 241 N DEER LN WEST JON GIRSCH FINAL DATE: 6/25/26 ALL TANKS TO BE TRAFFIC RATED AND TO HAVE TRAFFIC RATED RINGS,RISERS AND LIDS. SITE/PERMIT#: PARCEL NUMBER: AtM!,1JHUNTEk tcr•:slss,.,r:; 422055000901 SWG2026-00155