HomeMy WebLinkAboutSWG2020-00663 - SWG As-Built - 1/12/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SM Parcel# 12209-13-00010
Applicant Name Estate of Daniel Stanley Subdivision (Name/DivBlockw)
Applicant Address 18009 Seabeck Holly Rd
City, State, Zip Seebeck WA 98M Installer Nome Shae Oien
Site Address 100 E. Lucas Creek Rd BelfaiDesigner Name Tom Weaver
INSTALLATION CHECKLIST
Full System Instslle eft ❑Tank(s)Only ❑Dralnfield Only ❑Repair ❑other
System Type ATU 10 pressure Pretreatment Type Nullil BNR500
>5ft.from foundation? -------- - --- - ---- --- - -- - - - ❑wA ®YES ❑ No
>50A.from weNs7 -- --------------------------- ❑ ® ❑
Z >50 ft. from surface water? - ❑ ® ❑
fCleanout between building and tank? ------------------- ❑ ® ❑
U Tank battles present? - _ __ _ - ❑ ® ❑
4 24'access risers over each compartment?-____________ _ _. ❑ ® ❑
W Effluent flier installed?- - - - - - ---- - __ _ _ .y ❑ ® ❑
Septic tank size 500 TfeSh Tanls.I Manufacturer Hagerman
�0 D-box water level and speed levelsre and? ----- - -- --- - -- - ❑we ❑vEs ❑ No
QO Mandold/6box accessible from surface?---------------- - ❑U. M ❑
CQ Check valves instafed7 -- -- - ---- - - ❑ W ❑
f Transport tine Size Za Schedule/Class SCh 40
Bedrooms installed(check one) ❑ 2 ❑3 M♦ ❑ 5 ❑6 ❑CommerciaVo6xr ebemdond Mobile
>loft. from foundaticn7- N9 BoP 4Qi44ngoP4d klc0ib ___--_- ❑WA Elm 5] No
C >166IL from Viols?-7S?2pWaP/ar- - - - ---- - - - ------- ❑ ❑
W >100fLhomsurfacewater? -- - -- - -- -- - --- ---------- ❑ ❑
2 >10ft.from potable water lines?- ---- - - - ----- --------- ❑ ❑
>5ft.from property lines and easements?-- --- -- -- ------- ❑ ❑
>30 f.from downgradienl curtaiNbundation drains?---______- ❑ ❑
Drainfield level and observation ports present -------------- ❑ ❑
Z] Graveless chambers or ❑ Clean gravel used? (fleck one)
Proper cover installed over drainfiekl?-- -- --------------- ❑ ® ❑
Pump tank setbacks consistent with septic tWf/------ ---- - - - ❑ wA M ❑ No
Y Pump tank size 1.200 at Manufacturer Hagerman _
2
F2e'access riser(s)and accessible from surface? - - - - - - --- - - . I�1 ❑ ❑
R Alarm or Controf Panel Installed? - - - - - - - - - - - --- ---- - - - !^�J4 ❑ ❑
jControl Panel equipped with Timer/ETM/Counter-- ------- - - ® ❑ ❑
4 Pump installed in ❑ Bucket or t On Block or ❑ Other
IL
Pump Make/Model Liberty 280 JCI Floats or ❑Transducer
4 Tank draw down 1.5 In/min Pump capscity 36 opin Squirt Height 3 ft
Pump on time 2Min 15Sec pump of time 4 Hour Daily flow set st4BD apd
uw.ww�ame
Mason County OSS Installation Report pg. 2 Parcel# 12209-13-00010
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? • - ® YES O NO
If yes,please describe:
Were all components pumped out and properly abandoned per WAC24S-272A-0300? • - cif YES O NO
RECORD DRAWING
Thb b a ntam:ew toed and most a accurate and daserlpdvs mush to radocats In the teed oil maetosnsnce activities and Mora Mwiopms*t. Typical Maid
Drafts cadet prarrdtid a=Kohl orientation it layout.Septic/pump talc boon,North arrow.ratatnn drabibb.eadsfmg and pmpoaad buildhas,loosteo dwaas,%sla,Irra,
Mb.obas+ra'tan ports.ciearrouts.and other mabionance aeraas points.Incomplete Reectd Ceasing'may create adadonat delays in trial etststaft ippovai and Mated permits.
See Attached
1Record Drawing Attached
CERTIFICATION OF INSTALLATION •
INSTALLER DESIGNER/ENGINEER
1 certify that l installed the system in accordance with 1 certify that the system has been installed in actor-
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
form and•'"ttached Record Drawing is accurate, form and attached Record Drawing is accurate.
Signature of Installer 0V2_
i
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Shoe Oien ll
4
Printed Name of Signee % yrr �� �
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MASON COUNTY PUBLIC HEALTH ?i �I
The undersigned r w f NIA
rg approves this Installation Report and
Record Drawing on behalf of Mason County Public ,—.. E w .'tit
Health: •
^0 '•Rti II � tj,
1 2424
Signatur
e of Environmental Health Specialist Dale
(stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
Upested aQ1/1016
(1)"1°t7 6i/rm. In (2(
Existing 750 G tank and 1506
1" - 30' Pump tank to be abandoned SL#1 0-36" Sand loam and gravel
per MCHD standards 36-60" Loamy Med Sand and gravel
100 E L!icas r Rd
12209-13-00010 Old mobile not to be used as a habitable structure SL#2 Same as :141
Deck will need to be removed for drain field
If effluent transport must cross waterline, sleeve for 10' each side of crossing •
Effluent transport to be >50' from well and Schedule 40
‘4,5 - ea ii--r /AO 0 . / ti'
wt,
PROVED i
loo'Weil Circle JAN 12 2026 .,�, 5100333
MASON COUNTY ENVIRONMENTAL HEALTH � _ii.
RET o1,2V�o 2.3
tic system for this tot
�\OcidiSis2)'
a Vixisting
onto neighbors perky
/booTardc to and balled _per L4CND standards
+8' Valve x
`7- .. 330' t e1 +4'`f
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OLD • . 50' Well Circ
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_ 75' Well Circle • '�
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