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HomeMy WebLinkAboutSWG2026-00162 - SWG As-Built - 6/29/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00162 Parcel# 31904-51-00067 Applicant Name Sharon Rinehart Subdivision (Name/Div/Block/Lot) Applicant Address 20 SE Cabana Ave Fawn Lake#2 TR 67 City, State, Zip Shelton, WA 98584 Installer Name Maples Excavating Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ❑ Full System Installation ❑I Tank( )Own yr ❑ Drainfield Only ® Repair ❑ Other System Type Gravity Trench Pretreatment Type >5ft. fromfoundation? - - - --- - - - - - - -- - - -- - - -- - - - -- ❑ NIA • YES NO >50 ft.from wells? - - - - - - - - - - - - - - -- - - - - - - - - - --- - ❑ P1 ❑ >50ft.fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ III ❑ Cleanoutbetweenbuildingandtank? - -- - - - - - -- -- - - - - - -- ❑ 0 ❑ �y Tank baffles present? -- - - - - - - - - - - - - - - - - - - - - - - --- ❑ ❑� ❑ 24" access risers over each compartment?-- - - - -- - - - - - --- - ❑ ❑ W Effluent filter installed?-- - - - - - - - - - - - - - - - - - - - - - -- - - ❑ ❑I ❑ N Septic tank capacity(working) 1,060 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - - - - - - - - - - --- - ❑ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface? - - -- - - - - - - - - - - -- ❑ ❑ ❑ CC Check valves installed? - - - - - - - - - -- - - - - - - - - - - - - - - - ❑ ❑ ❑ oa E Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - - - - - - - - - -- - - - ❑ N/A ❑ NO >100ft. fromwells?- -- - - - - - - ---- -- - - - - - - ---- -- - - ❑ ❑ ❑ —> >100ft. fromsurfacewater? - - - - - - - - -- - - --- -- - - - - - ❑ ❑ W u. >10 ft. from potable water lines?- - - - - - - - - - , -` - - - - ❑ ❑ ❑ > 5ft. frompropertylinesandeasements?- - - - - - - - --- - - - - ❑ ❑ ❑ D > 30 ft. from downgradient curtain/ ation drains?- - - - - - - - - - ❑ ❑ ❑ Drainfield level and ob lon ports present - - - - - - - - - - -- - - ❑ ❑ ❑ ❑ Gravel ambers or ❑ Clean gravel used? (check one) ercoverinstalledoverdrainfield?- -- - - - - - -- - - -- - - - - - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?-- ---- - - - -- -- ❑ N/A ❑ YES No Pump tank capacity (flood) gal Manufacturer 24"access risers) and accessible from surface?-- --- - -- - -- - - ❑ ❑ Alarm or Control Panel Installed? - - - - - - - - - - - - - - - ❑ ❑ Control Panel equipped with Timer I ETM/Counter- - - - - - - ❑ ❑ ❑ 0- Pump installed in ❑ Bucket or ock or ❑ Other 0- Pump Make/Model ❑ Floats or Transducer Tank draw in/min Pump capacity gpm Squirt Height ft mp on time Pump off time Daily flow set at gpd Updated 8/11(2018 Mason County OSS Installation Report pg. 2 Parcel# ' 't O Lf-S1 a00(o-( ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ---------- -- - - - YES D NO If yes, please describe: ©(. '_{�ems - Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- YES O 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,a fisting 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 /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 and attached Record Drawing is accurate. form and attached Record Drawing is accurate. [iEgn;2tu&fe`of Installer Date Printed Name of Signee r' ti4 a MASON COUNTY PUBLIC HEALTH .' 5100349 `�`� The undersigned approves this Installation Report and PAULA.JOY JOHNSON . Record Drawing on behalf of Mason County Public Ltfi Health: ft c - Mm1 Signature of Environme 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 8212018 a � a toy ` i2'xlb° 7 1 Qar o+r / - fores� O �L�v 2 wsp �r (i n 2 43, ��tea— o o • � e 5 t e to so 4D O Clear?out • O 1,C60 Gallon Septic Tank (-K-t— 2-Compartment with Effluent Filter (3a j- w 2 as• APPROVED JUN 29 2026 510G349 br, MASON COUNTY ENVIRONMENTAL HEALTH N(`3 PAULA JOY,IQHrIS4PJ ti'' RET (c-C'_