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Home My WebLink AboutSWG2026-00172 - SWG As-Built - 8/5/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2026-00172 Parcel # 42012-22-90084 Applicant Name Kristin&Doug French Subdivision (Name/Div/Block/Lot) Applicant Address P.O.Box 54 City, State, Zip Shelton,WA 98584 Installer Name T.J. Goos Site Address 1481 E. Shelton Springs Rd. Designer Name Dale L.Tahja INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pressurized Bed Pretreatment Type NuWater BNR-600 >5 ft.fromfoundation7 - - ------ - --p------ ❑N/A •YES ❑ NO >50 R from wells? - ---- ------ B - 'l ❑ ® ❑ >5o ft from surface water? - - -----I--------- - ❑ U ❑ kZa- Cleanout between building and tank? jjf-JUL- e- , -- ❑ ® ❑ V Tank baffles present? - - - -- - -- ------------' " ' ❑ ■ ~a 24"access risers over each comps 6)t't_- -�{_--- - - ❑ ® ❑ WEffluent filter installed?- ------------ -- - - ® ❑ ❑ Septic tank capacity(working) 1,000 gel Manufacturer Hagerman O D-box water level and speed levelers used? ------------- - - ® N/A DYES O N 0O Manifold/D-box accessible from surface?---------------- - B ❑ ❑ mz Check valves installed? - - -- - ----- ------- ❑ ! O fTransport Line Size 2 inch Schedule/Class SGv 40 Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑5 ❑6 ❑Commercial/Other >10ft.from foundation?----- -------- -- ------- -- -- ❑ WA .YES ❑ NO 0 >100ftfrom wells?-_______ ________________ _____ ❑ U O W >100ft.fromsurfacewater? - - --- - ----------------- - ❑ ■ ❑ LL >10ft.ftompotablewaterlines?- --------------- ❑ ® ❑ Z > 5ft.from property lines and easements?-- ------ ---- - - O❑ e >30 ft.from downgradient curtain/foundation drains?-- ---- --- - e ❑ ❑ Drainfleld level and observation ports present --- -------- --- ❑ U ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?------------------- O N ❑ Pump tank setbacks consistent with septic tank?------------ - ❑ WA YES O NO Y Pump tank capacity(flood) 1.000 gal Manufacturer Hagerman Z 24"access riser(s)and accessible from surface?------------- ❑ ■ O Alarm or Control Panel Installed? -------- ---- ❑ ® O f Control Panel equipped with Timer/ETM/Counter- ---- -- -- - - ❑ ! ❑ Pump installed in ❑ Bucket or • On Block or ❑ Other Pump Make/Model Liberty 280 Floats or ❑Transducer Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 6.5 ft Pump on time 2.25 min Pump off time 5 hrs 57.75 min Daily flow set at 270 pd Morn County 083 bWWkdat Raped pg.2 P _ �'S ors ❑ r Mien eotlMMt eelfl as Prt d tlee roeaTrc\ Wen aloylgMdeifl' endpw'M vsa4S '141r-034Yt•-- RECORD QRAG err.p.�mr.rrrr...r.rarerlar.MmM rrrrr.rware�r.Marrrrre -..mc tsr+rr onrum�rrrawr.r+r.araw «+rsrr.rwwrwrra lasts - wwr.reeere.retir.rrr.■e•...e+r r°rM�r.wo rrr.r�rrrrr.rrrw.w«rrrr+wrr i Rams Deeefrg Aftdwd TION OF INeTAU4TCN W4ITAL, ER o ulMowm I oenity that I sailed We ryetem In.,cordons at' I cots?Met S 4Sim hen bee ltefa/«d h scow the aspen~sesmpsd APPRQVW'hr*Son awroa we m.asp*arabrr aerrps1 APPIROVED'by CmnyPab*1A000ld met styde*sflmMahoen MhMmtGIW*ACLthdhend0*&yone Ste how bean bbmdead by bdh the destpMf ah. 1 AMs Ms.been CISS%tIWKJ by boar and Mason O0w4PWMlo Heeah and meet N Sts$ myself and*awl Ow+ny Pt*&Heal«r and mast N and Meson CmoryCode& Safe end t•-_Cc I Mile omay OW N edamMron ae *bod on 1Me I«1rUeraa/Yyplet s!«b«Mfbn mnbired on fhb form and a«.caed add dewlbls assts. tam and Waefred ROOOId b wmeero. arMdtamed MASON GO1MTY PUIUC HEALTH r 10 The wrd@mWad Wprows bwe«mWWon Repod and 5100414 m b01daawn Qomry Pubic b DSs DTe LICENSED DESIGNER dBrMammsd HwM Deb (stamp *ndM_and dotal 1MB FFOIeAMRI BE SeNSEDNCMMU&E FOR R 1. VMVYOH THEMABONGUNN % SEE ubeamre S Ka la Milam From: DO NOT REPLY <forepy@masoncount ent: Wednesday,July 15, 2026 7:39 AM 70: Environmentalhealth .Subject: OSS Inspection request for french - 2026-00172 Submittal request for: french S. k Site Address: 1483shelton springs rdc �� ° t Permit Number:2026-00172 �U( ��, 'Parcel Number:420122290084 Installer Name:tyrone goos Installer Phone Number:3604900217 Installer Email Address:tgoos@mason-pudl.org Designer Name: dale tahja ,Designer Email Address: daletahja@gmail.com Inspection Request Date: 2026-07-15 nspection Type: Full System Comment\ Notes: please call after inspection,Thanks 13.360490021. hank you for submitting your final install request.The install should Request Date' and remain uncovered for three business days to allow time to inspect. Poor weather situations may staff be accommodated by contacting onsite staff, installer is responsible for obtaining Septic Designer/Engineer installation Record epa t t ithinls 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 o cover. Mason County Asbuilt Form, g� be submitted for final installation app MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2026-00172 ADDRESS: 1481 E Shelton Springs Rd PARCEL:420122290084 DATE: 7/15/2026 HOUSE TO DRAINFIELD DRAINFIELD TO HOUSE � for ; �ov Fc'enc 5100214 1 tb1 . H H / LICBlSEDDESw"NE4 � , jJ}`�'„ {� sYhs1'Lr q bn-� ,