HomeMy WebLinkAboutSWG2024-00329 - SWG As-Built - 8/8/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00329 Parcel # 22233-51-00004
Applicant Name Mark Spaur Subdivision (Name/Div/Block/Lot)
Applicant Address 37611 - 17th PI. S.
City, State, Zip Federal Way, Wa 98003 Installer Name Jack Johnson
Site Address 4400 Mason Lk. Dr. W. Designer Name Bob Paysse rn r g
INSTALLATION CHECKLIST v o
s
ElFull System Installation IITank(s)Only El Drainfield Only 0 Repair 0 Other 1
System Type N/A Pretreatment Type
>5 ft.from foundation? - 0 N/A ®YES ❑ NO
>50 ft.from wells? - - ❑ II ❑
Z >50 ft.from surface water? - ❑ II
H Cleanout between building and tank? - - 0 II ❑
V Tank baffles present? - - 0 ® 0
a24"access risers over each compartment?- - 0 II
`W Effluent filter installed?- - 0 MI El
Septic tank capacity(working) 1250 gal Manufacturer Infiltrator(plastic)
9 D-box water level and speed levelers used? - ® N/A ❑YES ❑ NO
DO Manifold/D-box accessible from surface?- - II 0
m— Check valves installed? - ill ❑
CIQ
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 0 6 ❑Commercial/Other
>10 ft.from foundation?- ® N/A ❑YES ❑ NO
0 >100 ft.from wells?- - 0 0 0
W >100 ft.from surface water? - - ® 0 ❑
u. >10 ft.from potable water lines?- - ® ❑ ❑
Z > 5 ft.from property lines and easements?- - ,® 0 0
12 > 30 ft.from downgradient curtain/foundation drains? - - ® 0 ❑
cl
Drainfield level and observation ports present - - ® 0 0
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ® 0 0
Pump tank setbacks consistent with septic tank?- - ❑ N/A 0 YES ❑ NO
• Pump tank capacity(flood) 540 gal Manufacturer Infiltrator
Z
< 24"access riser(s)and accessible from surface?- - ❑ I 0
aAlarm or Control Panel Installed? - - 0 0 0
2 Control Panel equipped with Timer/ETM/Counter- - 0 ❑ 0
m
n- Pump installed in I Bucket or ❑ On Block or ❑ Other
d PumpMake/Model LibertyFL30
� ® Floats or ❑ Transducer
d Tank draw down N/A in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at qpd
Updated 821/2018
Mason County OSS Installation Report pg. 2 Parcel# 22233-51-00004
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES Ell NO
If yes, please describe: _ __ _
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 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&manifold orientation&layout,Septic/pump tank location,Noith arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
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
for -nd all d Record Drawing is accurate. form and attached Record Drawing is accurate.
7-20-25
S re oft taller Date ►�1
Jack Johnson ►►ve ?s.
Printed Name of Signee s►► of N+
• I
I.
MASON COUNTY PUBLIC HEALTH i �,��', . ,a',r•�
The undersigned approves this Installation Report and 1 • �__ ! ,ter
Record Drawing on behalf of Mason County Public .�« %:%%
Health: EXPIRES
'lt fz s
Signature of Environme tal Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated8/21/2018
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EXPIRES / MASON
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AN ASBUILT/INSTALL SIGNOFF FEE WILL J /,rAO/v
BE CHARGED AT TIME OF INSTALLATION LAKE RECORD DRAWING
CUSTOMER: MARK SPA
LIR SCALE I:40 I � � I
PIONEER DIOGING, INC PARCEL#:�2933-51-00004
SEPTIC DESIGNS ADDRE_S: 4400 MASON LK DR W
3083 E.MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE
OFFICE-360-426-1803 FAX-36(1-427-2353 DESIGN PAGE ASBUILT