HomeMy WebLinkAboutswg2025-00014 - SWG As-Built - 10/30/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00014 Parcel# 22105-50-00042
Applicant Name Sykes Trustee Jane Subdivision (Name/Div/Block/Lot)
Applicant Address 811 E. Mason Lake Dr. E.
City, State, Zip Grapeview,Wa 98546 Installer Name Spear Construction
Site Address Same Designer Name Bob Paysse
INSTALLATION CHECKLIST
0 Full System Installation ®Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type ATU- Pretreatment Type NuWater BNR500
>5 ft.from foundation? - -" -•- ❑ N/A ®YES 0 NO
-
>50 ft.from wells? - _ O\ ; y 1 - - ❑ I 0
z >50 ft.from surface water? --- - Ly�1.7-Y l,, __ ❑ 0
Iii
• Cleanout between building and tan -� --O�1a-�� __' _ ❑ ® ❑
V Tank baffles present? - _ ___ ❑ ® ❑
a24"access risers over each compart ---- - _ ❑ ® 0
`W Effluent filter installed?- -_ _ Ill El
Septic tank capacity(working) 1 gal Manufacturer Infiltrator
S D-box water level and speed levelers used? - - • N/A 0 YES ❑ NO
oO Manifold/D-box accessible from surface?- - ® 0 0
mZ Check valves installed? - - ❑ ® ❑
G<
2 Transport Line Size Existing Schedule/Class
Bedrooms installed (check one) ❑■ 2 ❑3 ❑4 ❑ 5 0 6 ❑Commercial/Other
>10 ft.from foundation?- - ® N/A ❑ YES ❑ NO
O >100ft.fromwells?- - ® 0 0
4 W >100 ft.from surface water? - - Ill0 ❑
rt. >10 ft.from potable water lines?- - I ❑ 0
Z >5 ft.from property lines and easements?- it ❑
d >30 ft.from downgradient curtain/foundation drains? - - In ❑ ❑
Drainfield level and observation ports present - - ® ❑ 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) 1200 gal Manufacturer Infiltrator
< 24"access riser(s)and accessible from surface?- - 0 ® 0
a Alarm or Control Panel Installed? - - ❑ IN 0
2 Control Panel equipped with Timer/ETM/Counter- - ❑ I ❑
n
O. Pump installed in ❑ Bucket or It On Block or ❑ Other
ZPump Make/Model Used existing pump ® Floats or ❑ Transducer
a. Tank draw down 1 in/min Pump capacity 25 gpm Squirt Height N/A ft
Pump on time 1.75 min. Pump off time 4 hr Daily flow set at 240 gpd
Updated 8/21/2018
Parcel# 22105-50-00042 Mason County OSS Installation Report pg.2
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES El NO
If yes, please describe: Pumped existing and removed
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ® 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 end future development. Typical Record
Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drelnfleld,existing and proposed buildings,location of welts,waterlines,
wells,observation ports,c!eanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final Installation approval and related permits.
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 erri that any ueviations 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
end 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate.
1ol25/Z
htt
une of I staller Date 4ttl:=
Logan Spear t o`4
Printed Name of Signee , tt �1
MASON COUNTY PUBLIC HEALTH (Oa .
r a1001 , .
The undersigned approves this Installation Report and tt 4. RO • •• �•wvasa .
Record Drawingon behalf of Mason CountyPublic ' e
(WIRES
Health:
\'Z.J:M.All
Signature of Environmental ealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCAArNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated ernrcote
I\AASON ILK 7 N
-------H--- — -----...,
/ \
/ \
\ -\
\
// 1
i EXISTING DRAINFIELD
/ �'70 I RECENTLY RE-INSTALLED
/ 0- BY HOMEOWNER
/ U
/ 1 APPROXIMATE EXISTING
APPROXIMATE o TRANSPORT LINE
EXIST.
\/i
OSS PER RECORDS HOME1
1
WE'LL'. DESIGNER WAS NOT INVOLVED
1 W/ RECENT DRAINFIELD WORK
& NO INSPECTION OF WORK
_ — WAS COMPLETED PRIOR TO
\""- BACI<FILL. GRAVEL & PIPE WAS
N.
'� \\ � �\� ' REPLACED LIKE-FOR-LIKE ON
\
o \ THE EXISTING SYSTEM PER
p \\ \\ OWNER.
N - - \
-I\
FI____
,� � �C\EXIST.
GARAGE� - I r
s- �- i \
V ' OC T 3 p
I o / EXIST. I / __JSONcouNryEi7RQ
'�
ENLHEALTh
1\ WELL 1 / / HOME / �� RET \
\\ - / I -01 \ 1
\\ —I WELL \ y` 1
/ o �+g I
NUWATER / 1 (2 '
3.& PUMPTANK\
N. CZS/4' TO LAKE/ /' - \ - `\\ W . 4: RCRER��HSPAYSSE - ,`
N.
i 1..--- _- - \ .;rrjX C 1;�
\ , EXPintS /
\ MASON LAKE -- — — ' RECORD DRAG
CUSTOMER: )ANE SYKES TG^'I I IO Lk_�:N�
PIONEER DIGGING, INC. PARCEL # : JAN SYKES
SEPTIC DESIGNS ADDRESS 811 E MASON LK DR
THS RS NOT A SURVEY.REFERENCES INCLUCE ARVUCOi 1 COUNTY PRONGED
3083 E MA.sON BEN'N)N RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE Ru noR SQRVEvs,FG n NEASURENEN SANG COUN V cm CES:SV IiRENCED FOR SEvnC
OFFICE 36(}426-I803 F.AX 36X1427 2353 SHEET: ASBUILT SCALE 1N= SV PURPOSES
NT AGENCY RETAEWR OES,GNER NOT RESPONSIBLE FCR SETEATES UNRELATED MAY BE S.AJECT TO OTHER
SEPTIC COMPONENTS