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Home My WebLink AboutSWG2024-00241 - SWG As-Built - 9/4/2026 Docusign Envelope ID:F7491964-CEDO-8003-83DE-F654BE7EE76E Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2O24-O0241 Parcel# 321O4-54-OOO63 Applicant Name SHREVE KENNETH Subdivision (Name/Div/Block/Lot) Applicant Address 81 E FIR TREE LANE ALDERBROOK G &V#4 TRACT 63 City, State, Zip UNION Wa 98592 Installer Name Olympic Construction LLC Site Address 71 E Fir Tree Lane Designer Name Micah Halverson INSTALLATION CHECKLIST W Full System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑ Repair ❑Other System Type ATU to Pressure� trench Pretreatment Type BNR-500 >5 ft. from foundation? - - - - t R- r f n/7 71� - ❑ N/A ®YES ❑ No >50 ft. from wells? - - - - - + - I+' lr� }'Inn}Il� - ❑ ® ❑ Z >50 ft. from surface water? ---- - - - - .�d� �Z Hry'� - ❑ ® ❑ ?QZ - H Cleanoutbetweenbuildingandtank? ------ -- -- f-- -/PI-- ❑ ® ❑ L) Tank baffles present? - - - - - - - - - A - ❑ ® ❑ ~a 24" access risers over each compartm ?_ - -- -.- - - - - ❑ I ❑ W Effluentflter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ rn Septic tank capacity (working) 5OO+ Nuwater gal Manufacturer Sound Placement O D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A ❑ YES ® NO J k ❑ ❑ManifoldlD-box accessible from surface? mz Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ GQ E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 U ❑6 ❑Commercial/Other >10ft.from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ® YES LINO >100 ft.from wells? - - - - - - - -- - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ W >100 ft. from surtace water? - - - - - - - - - - - - - - ❑ ® ❑ LL >10ft.frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ U ❑ ZZ > 5ft.from property lines and easements?- - - - - - - - - - - - - - - - ❑ I ❑ K > 30 ft. from downgradient curtainlfoundation drains? - - - - - - - - - - ❑ ❑ D Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ LI ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed overdrainfleld?- - - - - - - - - - - - -- - - - - - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ❑ N/A YES LINO Y Pump tank capacity (flood) 1223 gal Manufacturer Sound Placement Z 24" access riser(s)and accessible from surface?- - - - - - ❑ ® ❑ f- Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ ❑ d Control Panel equipped with Timer/ETM /Counter - - - - - - - - - ❑ ❑ - . Pump installed in ® Bucket or ❑ On Block or ❑ Other Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer IL Tank draw down 2 in/min Pump capacity 45 gpm Squirt Height 6 ft Pump on time 1 min Pump off time 6 hrs Daily flow set at 180 gpd updated e21/201B Doousign Envelope ID:F7491964-CED0-0003-03DE-F654BE7EE76E Mason County OSS Installation Report pg. 2 Parcel# 32104-54-00063 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - ❑ YES Q 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 of maintenance activities and future development. Typical Record Drawings contain Drainfield&manilold enentatmn&layout Septio'pump tank location.North avow,reserve draineeld,ex:sting and proposed buildings,location of wells,waterlines, wells,observation pons,tleenouts,and other malnrenonce access points. incomplete Record Drawings may create additional delays in final installation approval and related permits. Initial Owners Initials: E Record 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 1 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. Signature of Installer Date Micah Halverson Printed Name of Signee MASON COUNTY PUBLIC HEALTH J The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public s10Dt� Health: U OE91011Bt E JWE, 0r1a 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 8/211201e N / \ f .3 Cl \ m \ ( w (\Z[ ) \\ / / CD r [ /F 3 » . 2 yyUI ° \ \ cm < ® x . ' N N ' — C \\ \ \ ! ^ \ .Sa±177 y <liz \ / \ \ ( \ \ Pt 'III ' Abbreviated f % � I \ \ eau _ AF#234495 M.Halverson KENNETH »»« Parcel# »,«woe m _ 1519 Shelton m 98584 e , e , er E LANE 71 ree ms a HaIversondesignhIc@outIook.com; «c v : �,� WA 98592