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HomeMy WebLinkAboutSWG2025-00342/ASBUILT - SWG As-Built - 9/4/2026 usign Envelope ID: F7491964-CED0-8003-83DE-F654DE7EE76E Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2O25-OO342 Parcel # 32104-54-00062 Applicant Name SHREVE, KENNETH Subdivision (Name/Div/Block/Lot) Applicant Address 81 E FIR TREE LANE ALDERBROOK G &Y#4 TRS: 61-62 City, State, Zip UNION Wa 98592 Installer Name Olympic Construction LLC Site Address 81 E Fir Tree Lane Designer Name Micah Halverson INSTALLATION CHECKLIST ❑ Full System Installation ©Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Gravity Pretreatment Type Septic tank >5 ft. from foundation? - - - - - - - - - - - ❑ NIA ®YES NO >50 ft. from wells? ---- - - � �� ❑ I ❑ Z >50 ft.from surface water? - - - - - ❑ ® ❑ hCleanout between building and tank? , - - -4L16--Ø-[J ; - - I F ❑ ® ❑ L Tank baffles present? - - - - - - - - - - -- - - - - - - ���- 7 ❑ ® El a24" access risers over each compartmIQY-- - - *LJL - ❑ ® ❑ W Effluent filter installed?- - - - - - - - I'- - ❑ ® ❑ to Septic tank capacity (working) 12OO gal Manufactuher Sound Placement O D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ® YES ❑ NO J 0 ❑O Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - ❑ mz Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - El El r7Q Transport Line Size 4" Schedule/Class ASTM 3034 f Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA ® YES ❑ NO >l00 ft.from wells? - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - ❑ ® El W >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ LL >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ 2 > 5ft.fromproperty lines and easements?- - - - - - - - - - - - - - - - ❑ ® El > 30 ft.from downgradient curtain/foundation drains? - - - - - - - - - - ❑ 0 ❑ G Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ® ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - ❑ U 0 Pump tank setbacks consistent with septic tank? - - - - - - - - - 0 N/A ® YES ❑ NO Y Pump tank capacity (flood) 127 gal Manufacturer Zoeller Pump Station Q24" access riser(s)and accessible from surface?- - - - - - - - - -- - ❑ ® ❑❑ Alan or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ 9 Control Panel equipped with Timer/ETM /Counter- - It 0 ❑ - - - - - - - - - d Pump installed in ❑ Bucket or • On Block or ❑ Other Pump Make/Model Zoeller N267 • Floats or ❑ Transducer Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time On demand Pump off time On demand Daily flow set at gpd updated erzlrzaie isign Envelope ID:F7491961-CEOO-8003-83DE-F654BEEE76E Mason County OSS Installation Report pg. 2 Parcel# 32104-54-00062 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - YES ❑ NO If yes, please describe: Pumped and Abandoned existing septic tank Were all components pumped out and properly abandoned per WAC246-272A-0300? - OYES ❑ NO RECORD DRAWING This is penman ant record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development Typical Record prawings contain: pralnfieldBmanifold orienratim 8layouL Septic/pump tank location,north snow,reserve dramfield,exisunq an proposed huilCings,lowvm of wells,waterlines. wells,observation ports,tleanours,and other maintenance access points. Incomplete Record coverage may create additional delays In coal installation approval and related permits. Initial Owners initials'. 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 I further certify that all information contained on this I further certify that all information contained on this forrry nd attached Record Drawing is accurate. form and attached Record Drawing is accurate. �.� Ignature of Installer Date Micah Halverson Printed Name of Signee / MASON COUNTY PUBLIC HEALTH p J ` The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public 610940S Health: Signature of Environment Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED ANO AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated W2112018 .LL X.Lc P!algel j8 Co O T a - G m \Jm v�l = AN fix' -1 rn � E r � u A 4� N Qa0 5l 133 ; —i � W H O` rr-tJl CD CD O Y r p0 A C E m on f s yi D 3 / L 3 N � 'm 3 � N a � o un 3 1 I; l p 65% U ❑ N ZN ❑ \JIZi_ Q n N N C n N O m N DU a F W W uw � N NA m � v n N � paQ 03 � � 3 3 z IP � B 1� ____ z ms— ' FF. �o ovy x/ Owned I'cant' S.Le Info. M.Halverson Design LLC KENNETH SHREVE Parcel# 32104-54-00062 PO Box 1519 Shelton Wa 98584 Maillnq. 81 E FIR TREE LANE 81 E FIR TREE LN Halversondesi nllc outlook.com UNION, WA 98592 PEvistN#