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Home My WebLink AboutSWG2025-00408 - SWG As-Built - 12/15/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00408 Parcel # 22105-51-00006 Applicant Name STEVE NESLUND Subdivision (Name/Div/Block/Lot) Applicant Address 14316 144TH STREET E City, State, Zip ORTING, WA 98360 Installer Name SCOTT JOHNSON/WATERTIGHT Site Address 4040 MASON LAKE DR WEST Designer Name ALEX PAYSSE/ALPINE S. D. INSTALLATION CHECKLIST l Full System Installation El Tank(s)Only ❑ Drainfield Only El Repair El Other System Type OSC X02 Pretreatment Type ATU/OSCAR >5 ft. from foundation? [ll) - - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - J- - � - ❑ 0 ❑ >50 ft. from surface water? - - - - - -ii- ! 2025 ❑ ❑ ❑ HCleanout between building and tank?;-- - - - y - - ❑ El ❑ U Tank baffles present? --- - - - - - - - - ❑ ❑■ ❑ a24"access risers over each compartm`e . - - El ❑■ CI W Effluent filter installed?- - ❑■ ❑ Cl co Septic tank capacity (working) 1000 gal Manufacturer HAGGERMAN PRECAST 0 D-box water level and speed levelers used? - - ❑I N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - El El co Check valves installed? - - ❑ El Cl OQ E Transport Line Size 1 Schedule/Class SCH. 40 Bedrooms installed (check one) ❑� 2 El 3 ❑4 El 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A UI YES ❑ NO O >100 ft. from wells?- - El ❑■ ❑ J >loo ft. from surface water? - - ❑ ❑ 0 W II >10 ft. from potable water lines?- - ❑ 0 ❑ z > 5 ft. from property lines and easements?- - Cl 0 ❑ cc > 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 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑� YES ❑ NO • Pump tank capacity (flood) 1000 gal Manufacturer HAGGERMAN PRECAST < 24" access riser(s) and accessible from surface?- - ❑ • El l` a Alarm or Control Panel Installed? - - ❑ I] ❑ E Control Panel equipped with Timer/ ETM/Counter- - ❑ © ❑ 0 a Pump installed in ❑ Bucket or ❑ On Block or ® Other PUMP SILO a• Pump Make/Model LOWRIDGE/E-30 1/2 HP Floats or ❑ Transducer a Tank draw down PER MNF in/min Pump capacity PER MNF gpm Squirt Height NA ft Pump on time PER MNF Pump off time PER MNF Daily flow set at 240 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # 22105-51-00006 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES ❑ NO If yes, please describe: 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 and future development Typical Record Drawings contain. Dra,nf,eld&manifold orientation&layout.Septic/pulp tank location,North arrow.reserve drainbeld,existing and proposed buildings.location of wells,waterlines. wells.observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create add.bonal delays in"tel installation approval and related pe'rr-ts. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 Record wing is accurate. form and attached Record Drawing is accurate. Signature of Installer Date i I or .S(4fr CTDh/LS0n s ' ' Printed Name of Signee i • MASON COUNTY PUBLIC HEALTH L r=e •�- sh `a z. ~ .. The undersigned approves this Installation Report and h Record Drawing on behalf of Mason County Public '7 4"X ALE i LOOS>An*: Health: k, "� i N "' I Zf 2.1-- Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated8Rf2ot8 \1 0\ \ \\ 11 1 I ' \\ BOO I \ 1 \ / m 1\\N 1 N 1 1 0 -< . .. / \ \ \ 1 I/ 1 1 , ‘ / 1 / •/ 1 I \N I 12' 1 I, \Ll ` i \ 2 BEDROOM\ \ r, 1 X02 DRAINFIELDI ` `TAS PER DESIGN\EXISTING CULVERT FOR \\SEASONAL DRAINAGE •1' 0 \ / I 0 GAL. X02 TANKS 0 -0/ 100 Q AS PER DESIGN 1 °\ \ .0 -IO O \ 1 *EXISTING 1TANK/DRAINFIELD \1 \ t 1 ABANDONED 1 1 I p� 1 EXISTING I 1p HOME II 1 y t, (2 BED) I I 1 9s 10. I o O '� �' I 1 2 OLJ 0Z. \ 0 , 4 0 I � s �: S iSZ.al.e'As4° / 1 ` ALEXLOI. PAY3.SE -t I\ \ 00#— / 1 ` 1 N / RECORD DRAWING 1 ii / \ OHWM (MASON LAKE) CUSTOMER: STEVE NESLUND TEST HOLE 1 TEST HOLE 2 TEST HOLE 3 /N 0-18 GMS 0-18 GMS NA / PARCEL: 22105-51-00006 A I............... I TH@ 18 TH@ 18 ALPINE SEPTIC SITE:4040 MASON LAKE DR.W. ROOTS-18 ROOTS-18 —DESIGN— ` ALEX L PAYSSE,DESIGNER SHEET: ASBUILT SCALE: 1"=20' DISCLAIMER: THIS IS NOT A SURVEY. REFERENCES INCLUDE APPLICANT/COUNTY PROVIDED PLATS OR 3089 E MASON BENSON RD SURVEYS.FIELD MEASUREMENTS AND COUNTY GIS. DESIGN INTENDED FOR SEPTIC PURPOSES ONLY. GRAPEVIEW WA 98546 PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER DEPARTMENT/AGENCY REVIEW. DESIGNER NOT ` 360-607-1546 IO c.5 I, 12 RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS.