The URL can be used to link to this page

Home My WebLink AboutSWG2025-00371/ASBUILT - SWG As-Built - 9/4/2026 Mason County OSS Installation APP MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Parcel# 61928-43-00020 rApplicantAddress r SWG 2025-00371 Subdivision (Name/Div/Block/Lot) e BRITTANY K KING ress PO Box 1519j Shelton Wa 98584 Installer Name OI m is Construction LLC p Desi nerMicah Halverson 6711 w sacs p cioouanum rd_ 9 IpsTALLM1ON CHECKLIST Repair ❑Other��- ® Full System Installation ❑Tank(s) Only ❑ Drainfield Only Pretreatment Type septic tank _ System Type Sand Augmented Bed _ _ _ ❑ NIA ®YES ❑ NO >5 ft. from foundation? - - - - -- ❑ ❑ >50 ft. from wells? - - - � - � Y >50 ft. from surface water? - - - 0 ❑ m1 ❑ f Cleanout between building and tank? - r - G 2 D 2Tl7F ❑ Tank baffles Present? - - - - - ,- - - - ® ❑ 24" access risers over each compartm ❑r�?- - - 9 O -- - - - - W Effluent filter installed?- - - - ❑ Infiltrator 1271 gal Manufacturer Septic tank capacity (working) NO G D-box water level and speed levelers used? - - - - - ❑❑ NIA O YES J _ _ _ _ _ _ _ _ _ _ _ _ ❑ �O Manifold/D-box accessible from surface?- _ _ _ ❑ f9Z Checkvalves installed? - - - - - - - - - - - - " pQ 2,. SchedulelClass 40-- 2 f Transport Line Size�---- 3 %4 ❑ 5 ❑6 ❑Commercialbother Bedrooms installed (check one) ❑ ❑ NO NIA ® VES ❑ ,10ft. from foundation?- - - - - - - - - - - - - ❑ ❑ >ioo ft. from wells? - - - - - - - - - - - - - - - - - - - - - - - - --_-_- ❑ ❑ >100 ft. from surface water? - - - - - - - - - - - - - - ❑ ® ❑ tu ❑ M >10 ft. from potable water lines ❑ Z > 5ft. from property lines and easements?- - - - - - - - - - - - - " " ❑ ❑ > 30 ft. from downgradient curtainlfoundation drains? - - - - - - - - - _ ❑ Grainfield level and observation ports present - - - - - 0 ❑ Graveless chambers or IN Clean gravel used? (check one) ❑ ® ❑ Proper cover installed over tlrainfield?- - - - - - - - Pump tank setbacks consistent with septic tank? - - - - 0 NIA 4 YES ❑ NO Manufacturer Infiltrator Y Pump tank capacity (flood) 1500 gal ❑ ❑ Z 24" access riser(s) and accessible from surface?- - - - -- - " - -- - ❑ ❑ Alarm or Control Panel Installed? - - - - - - " - - - - ® 0 0 Control Panel equipped with Timer I ETM 1 Counter� - - - - Orenco Flow intlucer Other a Pump installed in ❑ Bucket or ❑ On Block or M Transducer Orenco PF 5005 ❑ Floats or a Pump Make/Model g ft 45 gpm Squirt Height a Tank draw down 2 inlmin Pump capacity Daily flow set at 380 9Pd Pump off time 1:15hr Pump on time 30sec updated erz,I2O,e \ Mason County OSS Installation Report pg. 2 Parcel# 61928-43-00020 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 a maintenance activities and future development. Typical Record Drawm ta Dremneld&manifold orientation&Layout,septiclpump rank location.North arrow,reserve dralmleld.existing and proposed buildings,location of wells,waterlines. gs con were observation Cods,CIBan0Ws,arid Other maintenance ara'Rss points. Incomplete Record Orawhg3 may create additional delays in final installation approval and relate pertni S Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI ENGINEER I certify that!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 furthe ertify that all information contained on this I further certify that all information contained on this form d attached Record Drawing is accurate, form and attached Record Drawing is accurate. ignature of Installer Date Micah Halverson 2 Printed Name of Signee =(Jju� TY PUBLIC HEALTH 97r/K� d approves this Installation Report and �// $�p g on behal/of Mason County Public l VI" a '1I11UAironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updamdeav2lne Tabloid 11"X17". m 3 m Q d E — T _ / — O w o 0 3 _ `s W Sat$OP-Cloquallum Rd o O e \ L �on z. o o N '''o. =� 3 a I A A A N m nQ It HI L N d N Q Q CO^ OLL R .. .. 4. '< N 3 N a F O S o Y ACNNC 00 Od ooh 3 o N d - -o ' D N W c 0 3 o w 0 3 c n o m Q m m N � N A S F m 09 0 - � m F N S 0 m �`L U r3 'o 3C� 220' M.Halverson Design LLC a° BR I I TANY K KfNG Site Info Parcel # 61928-43-00020 PO Box 1519 Shelton Wa 98584 d= 6711 W SATSOP CLoouALLuM A Halversondesi nllc@outlook.com - RD, ELMA98541 6711 W SATSOP CLOQUALLUM RD 1 FEvISIQN