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Home My WebLink AboutSWG2025-00360 - SWG As-Built - 6/29/2026 Docusign Envelope ID: 1 DE744B4-9677-837F-8078-2CB94FE6BF33 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2025-00360 Parcel # 22016-33-00000 Applicant Name TAMMIE FFL n Subdivision (Name/Div/Block/Lot) Applicant Address 6131 F PICKERINC Rfl City, State, Zip SHELTON WA 98584 Installer Name JAMIE WORKMAN Site Address 6131 E PICKERING RD Designer Name MICAH HAI VERSON INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type OSCAR XO2 Pretreatment Type X02 + OSCAR >5ft. fromfoundation? - - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ N/A ® YES El NO >50 ft. from wells? - - - - - - - - - - - - - - - - El ® ❑ z >50 ft. from surface water? - - - - - - i8� ❑ ® El HCleanout between building and tank? - - - - - - - - - - - El ® El Tank baffles present? - - - - - - - - - - �UN 2-Z-06- - ❑ ® ❑ 24" access risers over each compartm ?- - - - - - - ❑ X❑ ❑ W Effluent filter installed?- - - - - - - - -L± —_ ❑ ® ❑ Septic tank capacity (working) EXISTING 1 p6al Manufacturer INFILTRATOR `0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A ❑ YES ® NO �O Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - - ❑ ® El C9z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ El 2 Transport Line Size 1" Schedule/Class SCH40 Bedrooms installed (check one) El 2 ❑ 3 ®4 El 5 ❑6 ❑Commercial/Other >10ft. fromfoundation? - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ N/A ® YES ❑ NO >100ft. fromwells?- - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ El W u. >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ Z > 5 ft. from property lines and easements?- - - - - - - - - - - - - - -- ❑ ® ❑ Q W > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ X❑ El 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 Y Pump tank capacity (flood) 1060 gal Manufacturer ROTH Q24" access riser(s) and accessible from surface?- - - - - - - - - - - -- ❑ ® ❑ ? - - - - - - - - - - - - - - - - - - - - - Alarm or Control Panel Installed? ❑ ® ❑ Control Panel equipped with Timer/ ETM / Counter- - - - - - - - - - - ❑ X❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or X❑ Other Pump Basket Pump Make/Model pFR mANI IFACTI IRFR ® Floats or ❑ Transducer a Tank draw down per mfg in/min Pump capacity per mfg gpm Squirt Height N/A ft Pump on time peLmfg Pump off time per mfg Daily flow set at 360 gpd Updated 8/21/2018 Docusign Envelope ID: 1 DE744B4-9677-837F-8078-2CB94FE6BF33 Mason County OSS Installation Report pg. 2 Parcel# 22016-33-00000 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - -- YES ® No If yes, please describe:N/A 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. Initial OWNERS INITIALS: Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER / 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 al/information contained on this f q ,At�gched Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of Installer Date LG Printed Name of Signee j / t MASON COUNTY PUBLIC HEALTH a The undersigned approves this Installation Report and \J I Record Drawing on behalf of Mason County Public 610W0D rdAM►w.v�soa Health: EKE DE 1 I?, F>'�Fc rf° /_.3 Signature of Environmental 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 �a la Milani From: Sent: DO NOT REPLY < To: Wednesda2026 1 no masoncountywa.gov> ySubject; June 3, 2026 10:59 AM Environmen talhealth OSS Inspection request for Tammie Feld -SWG2025-00360 Submittal request for:Tammie Feld I Site Address: 6131 E Pickering Rd Permit Number:SWG2025-00360 II LELfl Parcel Number:220163300000 JUN 0 31016 Installer Name:Jamie Workman By Installer Phone Number:360-463-9573 Installer Email Address: buzzworkman29@gmail.com Designer Name: Micah Halverson Designer Email Address: halversondesign@outlook.com Inspection Request Date: 2026-06-03 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. . 1 JL .'a { } -4 Docusign Envelope ID: 1DE744B4-9677-837F-8078-2CB94FE6BF33 X� CALLOUTS 1) Existing sewer lines from dwellings 7) Power from Garage z N o 2) Sewer Cleanout 8) Power Disconnect & - 3) Existing 1060 Infiltrator Septic Tank SWG2019-00253 LF1 P-RF-ARA control panel 4) Failed Drainfeild Area 9) Roth 1060 Discharge Tank 5) 1" Sch40 PVC Air Line 10) Vent line installed in inlet of discharge tank. 6) HB-80 Aerator Pump � o 0 o Q 4 Bedroom On-Site Wastewater Asbuilt SWG2025-00360 z o w N Y \ N U Seasonal Drainage Ditch 4 L W Driveway 20' 5/ope___ IF co NI o L Z I ( V CD W 1 Bed O Garage =ii � O ADU c w S Owner/ „ Applicant Sch40 PVC 10 APPROVED ROVED pe oho O (a�S —j IC) U S F R JUN 2 9 2026 a� '/ 3°' c` c MASON COUNTY ENVIRONMENTAL HFe 1.Tt' a o Q5� Initial Initial / This is not a survel} s1004M O U) to I / This Asbuilt Drawing is intended for the purpose of p pNER i— ) / 2 locating and maintaining the septic system on this parcel. / Measurements and distances are approximate. FY-mare.na�rs��l N / X It is advised by septic designer Micah Halverson to use a licensed surveyor to determine lot lines, ` / m > 4 elevations,topography and to provide a legal site plan. 30' 20' 0' 10' 20' 30' Z O CB Owner is responsible for establishing all property lines, �p d 2 easements and/or right-of-ways. Scale: 1'.=20' Insl2ection Date•6!05/2026