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Home My WebLink AboutAFTER THE FACT - SWG As-Built - 2/11/2025 .. . .. .. ..... .. ... '11 F� �t ` IC-6 t I (, Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number swG4O / 7 -ODZP,Z Parcel# 31904-52-00020 Applicant Name Vitruvian Design 1-Lc Subdivision (Name/Div/Block/Lot) Applicant Addres94241 NE Woodinville Duvall Rd#308 Fawn Lake Div 3 Lot 20 City, State,Zip Woodinville, WA 98072 Installer Name Unknown Site Address 50 SE IRIS PI,Shelton Designer Name Greg Waltrick INSTALLATION CHECKLIST ® Full system Installation ❑Tank s)Only Drainfield Only ❑Repair ❑Other System Type vl Pretreatment Type Glendon >5ft.from foundation? --- --- --- - - - - -------- - -- - - - ❑NIA ]YES NO >50 ft.from wells? --- - ----------------------- - - ❑ ❑ ❑ Z >50ft.from surface water? - ---------------------- - ❑ �] ❑ f- Cleanout between building and tank? ------------------- ❑ ❑ U Tank baffles present? - - - - ------ ----------------- ❑ �] ❑ a24'access risers over each compartment?------- --------- ❑ Q(] ❑ WEffluent filter installed?- - -- - -- - ----- --- -- --------- ❑ ® ❑ Septic tank size 1,200 gal Manufacturer Co,vc A, 7t & DC6P O D-box water level and speed levelers used? --- -- - - N NIA ❑YES ❑ NO 00 Manifold/D-box accessible from surface?------- ❑ ❑ s?= Check valves installed? - -- - - - ---------- --- - - - - - -- ❑ ❑ ❑ OQ f Transport Line Size Schedule/Class Bedrooms installed (check one) 42 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?------------------------- - ❑ WA ® YES NO >100 ft.from wells?--- ------------------- ------ . ❑ ❑ ❑ -� >100 ft.from surface water? -- ---------------------- ❑ ❑x ❑ W M >10ft.from potable water lines?------ ---------------- ❑ G ❑ QZ >5ft.from property lines and easements?----- ---- ------- ❑ ® ❑ K >30 ft.from downgradient curtaintfoundation drains?--------- - ❑ ® ❑ Drainfield level and observation ports present - - - - - ------ - - - ❑ ® ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--------- - -- ---- - - ❑ [a] ❑ Pump tank setbacks consistent with septic tank?-- - - - - - -- - - - - ❑ NIA ® Vas ❑ No ZPump tank size�zOU cal Manufacturer GO�r/L?�fl.' /8> OpCP Q 24"access dser(s)and accessible from surface?--- - - - - ------ ❑ [a ❑ 0. a Alarm or Control Panel Installed? --- - ---- - -- - --------- ❑ 13 ❑ jControl Panel equipped with Timer/ETM/Counter----------- Iff ❑ ❑ a Pump installed in ® Bucket or ❑ On Block or ❑ Other Pump Make/Model'z,,T�e G.r4#r S-Ats? //" Q9 Fleets or ❑Transducer o,r. EQVIVFtaWr a Tank draw down /min Pump capacity aom 5"rt Height fl Pump on time /\/!4 Pump oft time N A Daily flow set at LYO apd UW demrzo+e Mason County OSS Installation Report pg. 2 Parcel x 31904-52-00020 ABANDONMENTRECORD Were existing septic components abandoned as part of this project? ----- - - - - - - - --- ❑ YES In NO If yes, please describe'. Were all components pumped out and property abandoned per WAC246-272A-0300? - - - ----- ❑ YES [3 NO RECORD DRAWING Thia b 1 Immanent ncaN and must M bttunb and dncrlpWe onoupN to nbcrb In MI nM ar maim mane.mmanua and Nwn bnlopnu2 TY9Ia1 Rextl Gew.y when: ptlMNd b menilW crienletbn b IeywA.yplklpurry Wk bwllon.NOM nuw,nxrvs d'didaH,o]LNp nd prowaetl EUW'vps.bmtlen gv.'nls,waM�dna, —da,oE...p..Uadanda,nM punt, Irvcumnsto Revd bm,,.msy..aduouni Mrys in A.vuYI.n ep,.v aM rWled psamans OL W' l n 2vN71 . � L44- a-S b4( I4- a,�- Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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 atl 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 VV1� Printed Name of Signee MASON COUNTY PUBLIC HEALTH ` The undersigned approves this Installation Report and 'THOMAB E�WEAVER'. Record Drawing on behalf of Mason County Public ^- NER'- Health: S^2� Signature ofEnv/ronmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED ANDAWdl-ABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 4daundsolm'. 120' I 38 ' 2e 542J4 i Cx<2�/uoJ z1 I 1 'L gox a / tt 126.65' 150.71' z�•X y8 Z 60Awl M pwp I/oriL �•{!L / swU '1 0. \1 r, fow Mgstn Iy. 9 m y Z� V) Ire A Iris Place APPROVED FEB 11 2025 \ MASON COUNTY ENV]RON MENTAL HEALTk s• RET VEP', I N" 1° = 20' 2�G�zS 31904-52-00020 50 SE Iris PI