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HomeMy WebLinkAboutSWG2026-00257 - SWG As-Built - 9/25/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00257 Parcel # 41909-11-00020 Applicant Name Kenneth Barnes Subdivision (Name/Div/Block/Lot) Applicant Address 410 W Wivell Rd City, State, Zip Shelton, WA 98584 Installer Name Maples Excavating Site Address same Designer Name Arrow Septic Designs, Inc___ INSTALLATION CHECKLIST Full System Installation ❑Tank(s) Only ❑ Drainfield Only A Repair ❑ Other System Type Sand-Lined Pressure Bed Pretreatment Type >5ft. fromfoundation? - - - - - - - - - - - - - - - - - - - - - ,,+ - - - - [] NIA / YES ENO >50ft. fromwells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ W >50 ft. from surface water? - - - - - - - - - -- - - - - - - - -`- ❑ ❑ Cleanout between building and tank? - - -Yc -t 1r - - • Q Q ❑ Tank baffles present? - - - - - - - - - - -��- - - - - - - - - - - - - - CJ U ❑ 24" access risers over each compartment?- - - - - - - - - Q Q■ Q WEffluent filterinstalled?- - - - - - - - - - - -- - - - - - - - - - - - • ❑ U ❑ Septic tank capacity(working) 1.200 gal Manufacturer Existing Concrete 2-Compartment 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - Q N/A ❑ YES Q■ NO Od Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - • Q C cI Check valvesinstalled? - - - - - - - - - - - - - - - - - - - - - ❑ ❑ Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑3 ®4 ❑ 5 ❑6 []Commercial!Othe., >10ft. fromfoundation?- - - - - - - - - - - - - - - - - - - - - - - - - - QN/A UYESS QNO >100ft. fromwells?- - - - - - - - - - - - - - - - - -- - - - - - -- - - - ❑ II ❑ jjj >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ 0 LI #s, >10ft. frompotablewaterlines?- - - - - - - - - - - -- - - - - - - - - - - ❑ ❑■ ❑ > 5 ft. from property linesand easements?- - - - - - - - - - - - - - - - ❑ U] ❑ > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ 0 Q Drainfield level and observation ports present - - - - - - - - - - - - - - (_] U ❑ Graveless chambers or U] Clean gravel used? (check one) Proper cover installed over drainfield? - - - - - - - - - - - - - - - - - - ❑ ■❑ Pump tank setbacks consistent with septic tank?-- - - - - - - - - - - - — N/A U] YES ❑ NO Pump tank capacity (flood) 1,250 pal Manufacturer Infiltrator 24"access riser(s)and accessible from surface?- - - - - - - - - - - - - E Alarm or Control Panel Installed? - - - -- - - - - - - - - - - - - - - - - ❑ ® ❑ Control Panel equipped with Timer/ETM I Counter - - - - - - - - - - Q 0 ❑ Pump installed in Q Bucket or ® On Block or ❑ Other Pump Make/Mode! Zoeller E189 LIEFloats or ❑ Transducer Tank draw down 3 in/min Pump capacity 87 gpm Squirt Height 5.5 ft Pump on time 1.3 min Pump off time 6 hr Daily flow set at 480 gpd upclateO&21/2018 Mason County OSS Installation Report pg. 2 Parcel# 4U Ode - L I — OOto ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - -- - - - - - - - - - - - YES ❑ NO If yes, please describe: ©LA � X) �� ! Were all components pumped out and properly abandoned per WAC246-272A-0300? - --- -- - ❑ YES 'x'10. ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance aetivitaea and future development Typical Rawrc Drevengs contain: Drairdield&nanifold onentmon&layout,Sep c/purnp tank loco on,North arrow,reserve drainfeld,e7Cstng and proposed buddings,location of wells,waterlines, welts,observation ports.deanouts,and other maintenance access pomis. Incomplete Record Dravings may create additional delays in Dnal aistaflaton approval and related permits. eQ A4 & 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 /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 �i✓t��tt�' V���(�� GGG"'.."`III Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report end r W 1 Record Drawing on behalf of Mason County Public Health: y` PAULA JOY JOHNSON frN --Z -Z Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUB!1C VIEW ON THE MASON COUNTY WEB SITE acc a2i2ote APPROVED SEP 25 2026 ASCN COUN Y EWRONYENTAL HEALTH \ \ RET Audio-Visual Ala0 rm - C?eanout Zx $ 3 1200 Gz on Septic Tank 2-Compartment with Effluent Filter 3 t-ZSOG&llon Pump Chamber Q tdLaeL.0) t& `���\ ��' Z ' �' ■oak � �h ��� �� � 510349 •J��'``�1 PAULA JOY JOHNSON S $ems G L5- 5`0 7S [oo ote to installer"" Sleeve waterline when within 10' of septic transport lane. Maintain 10 minimum between water — line and septic tanksidrainfield. La W- C t V Jk 4, S ,.4-p\ MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2026-00257 ADDRESS: 410 W Wivell Rd PARCEL: 419091100020 DATE: 9/23/2026 HOUSE TO DRAINFIELD far t � DRAINFIELD TO HOUSE Kayla Milan' O NOT REPLY xnorel,ly�4(PPmecontountywo,gov Sent :, rot i Monday, September i'1. .1026109 PM : i=tt a ti)I eI talhetrlth t")tis In'apettion request hoi Itrs(_p��l,i r'r Y 'nn+'th k►arrteS 5W G2026 00251 5! Sub itt�il request for:Angela&Kenneth Barnes. Site Address:410W.Wivell Rd. fi permit Number:SWG2026-0025? Parcel Nunsber:419091100020 installer Name:Shane Maples installer Phone Number:360-229-3043 installer Email Address: 3pi5_excavaflg@h0tml orn r 1 :.'r`' `� Designer Name:Paula Johnson Designer Email Address: paulaj@hctc-com inspection Request Date: 2026-09-21 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 Asbullt Form, Record Drawing,and Installation fee must be submitted for final installation approval. ff