HomeMy WebLinkAboutSWG2023-00337 - SWG As-Built - 11/21/2025 CLEAR FORM
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00337 Parcel # 422125001009
Applicant Name Shawn Benson ASubdivision (Name/Div/Block/Lot)
Applicant Address 9509 39th Lp NE
City, State, Zip Olympia, WA 98516 Installer Name SCOTT JOHNSON
Site Address 7452n N HS Highway 101 Designer Name Adam Hunter
INSTALLATION:CHECKLIST
❑ Full System Installation ❑ Tank(s) Only ❑ Drainfield Only E Repair ❑Other
System Type 4461 (Ornrw;QJ 055 -Ai tr" Pretreatment Type fATC-4 ft-s- 1?- U
>5 ft. from foundation? - i re-sStAt Vat ❑ NIA 1!� YES ❑ NO
>50 ft. from wells? - - ❑ ® ❑
Z >50 ft. from surface water? - - Ill [] El
4 Cleanout between building and tank? - - ❑ i/ CIo Tank baffles present? - - El ❑
E-- 24" access risers over each compartment? - - ❑ El ❑
a
W Effluent filter installed?- - ❑ 14 ❑
0)
Septic tank capacity(working) '' ,t75 gal Manufacturer CO R Crn creme
9 D-box water level and speed levelers used? - - Igl N/A ❑ YES ❑ NO
,
00 Manifold/D-box accessible from surface?- -
ill N El
412 ' Check valves installed? - - K. ❑ ❑
.2 Transport Line Size 1 . 3 Schedule/Class jC A /-1O
Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 Commercial/Other
>10 ft. from foundation? - - ❑ N/A gg YES ❑ NO
a >100 ft. from wells? - - ❑ Tcl ❑
w >100 ft. from surface water? - - ❑ Cl IN
u„ >10 ft. from potable water lines?- - ❑ 14 ❑
Z > 5 ft. from property lines and easements?- - ❑ k] ❑
c > 30 ft. from downgradient curtain/foundation drains? - - ❑ .® ❑
Drainfield level and observation ports present - - ❑ IK ❑
❑ Graveless chambers or Et Clean gravel used? (check one)
• Proper cover installed over drainfield?- - ❑ El ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ,YES ❑ NO
Pump tank capacity(flood) 6358 gal Manufacturer ( (1'a Coocirek
4 24"access riser(s) and accessible from surface?- - ❑ K ❑
a Alarm or Control Panel Installed? - - ❑ Er ❑
Control Panel equipped with Timer/ETM/ Counter- - ❑ ® ❑
a Pump installed in IN. Bucket or ❑ On Block or ❑ Other
a' Pump Make/Model �`(1��k �15t111/� Floats or ❑ Transducer
R. Tank draw down , 4 i /min Pump capacity ``q .78 gpm Squirt Height ,) ft
Pump on time 0. Q18 tPAW1 Pump off time q.08 Vu11V\ Daily flow set at (1)y0 gpd
RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH
RECORD DRAWING
▪ Drainfield&
manifold orientation
&layout
• Trench/bed
dimensions and
critical distances
within layout
Septic/pump tank
placement
SEE ATTACHED
• Location of
buildings
▪ Observation ports&
clean-out locations
❑ Location of wells,
surface water,&
roads
• Undisturbed native
soil between
trenches
❑ North Arrow
If the designer or installer feel the need for additional information/comments, it may be attached.
Record drawing may also be on a seperate page attached. No. Pages Attached 1
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
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
I further certify that all information contained on this I further certify that all information contained on this
form and attached cord Drawing is accurate. form and attached Record Drawing is accurate.
11-3-25
Signature of Installer Date
Scott Johnson
1/4/25
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH , ' .
The undersigned approves this Installation Report and
•
Record Drawing on behalf of Mason County Public
ADAMJ HUNTER
Health: •:".
11/1/2-c
26
Signature of Environmental Health Specialist Date (designer's stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
revised 1/22/2014
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