HomeMy WebLinkAboutSWG2025-00287 - SWG As-Built - 3/4/2026 CLEAR.FORM.
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00287 Parcel# 123303290263
Applicant Name ROBERT SATRAN Subdivision (Name/Div/Block/Lot)
Applicant Address 191 NE KIMBERLY DR TR 26 OF GOVT LOT 3 LOT:3 OF SP#1479
City, State, Zip BELFAIR WA 985288218 Installer Name Jack Johnson
Site Address 181 NE KIMBERLY DR Designer Name JimZimny
INSTALLATION CHECKLIST
® Full System Installation O Tank(s)Only O Drainfield Only O Repair O Other
System Type Gravity-trenches -- treatment Type
��y --:',. '‘V-i ! - - ❑ N/A ®YES ❑ NO
>5 ft. from foundation? - �-=-=: "-' r'-%,-=T-��`
>50 ft. from wells? y'" ^`.. `, f - O ® O
ii >50 ft. from surface water? - ;,. �, �B �-�v�- - -- - ❑ 0 ❑
cC Cleanout between building and tank? -;';'--� --1- ❑ ❑ O
l-
O Tank baffles present? - ``. ,�i ® 0 O
P24"access risers over each compartment?- �' �,� '-''`- - O El O
111
Effluent filter installed?- `�.� - ❑ ® O
CO
Septic tank capacity (working) 1250 gal Manufacturer Hagerman
C) D-box water level and speed levelers used? - - ElN/A ® YES ElNO
o#:) Manifold/D-box accessible from surface?- - ❑ ® CI
m Check valves installed? - - ® O O
®Q
m Transport Line Size 4" Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 0 3 ❑4 O 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A Q YES ❑ NO
® >100 ft. from wells?- - ❑ 0 O
W >100 ft. from surface water? - - O ® O
it >10 ft. from potable water lines?- - O ® 0
z >5 ft. from property lines and easements?- - O ® ❑
d > 30 ft.from downgradient curtain/foundation drains?- - ❑ ® ❑
® Drainfield level and observation ports present - - O ® ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - O ® O
Pump tank setbacks consistent with septic tank?- - O N/A O YES O NO
he Pump tank capacity(flood) gal Manufacturer
Z
cc 24" access riser(s)and accessible from surface?- - ❑ O 0
a_ Alarm or Control Panel Installed? - - ❑ ❑ ❑
• Control Panel equipped with Timer/ETM/Counter- - O O 0
a- Pump installed in ❑ Bucket or O On Block or O Other
1
Q' Pump Make/Model ❑ Floats or
� ❑ Transducer
D
Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated$12112018
Mason County OSS Installation Report pg. 2 Parcel# 1233°3 Z[OZ(o 3
ABANDONMENT RECORD ,
Were existing septic components abandoned as part of this project? - - ❑ YES 0 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300?- - O YES O NO
RECORD DRAWING
This Is a permanent record and must bo accurate and descriptive enough to re-locate in tho need of maintenance activities and future development. Typical Record
Drawings contain: Drainfield 8 manifold orientation 8 layout,Septic/pump tank location,North arrow,reserve drainrreld,existing and proposed buildings,location of wells.waterlines,
wells,observation ports,deanouts,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 l 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
fo Ind alt hed Record Drawing is accurate. form and attached Record Drawing is accurate.
A /7—/6P-2. ..c
Si um of Installer
a Date
•"V'o ce, r>d` h v 5 me)
Printed Name of Signee S`II
MASON COUNTY PUBLIC HEALTH 44 z Sr.• .;
The undersigned approves this Installation Rep: air -1.
Record D -, in on behalf of Mason County Public '� [ %, 4`'' N�.Ih
Health: 11/41? �' y^i p• 20 2,33 1,,
Y /t r, O
LI NS DESIGNER
02026,
37Signature of Environmental altit Specialist Date�1�J//p,.., (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABT FOR P11t l ,VIEW ON THE MASON COUNTY WEB SITE Updated 8/2112018
CCAZTH
County Stamp
Asbuilt _
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el306 190' /PI '
R ; 301' o 2026
75' A BAR
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T{-11E1 MASO pJR
- 75,
d-box Designer tamp
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— — 27' s/o el
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LF" •.DE.IGNER
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d 40 i. , Designer Info:
O co Jim Zimny
O LEI
M L APD
D/W 7178 Windflower PL NW
SD Seabeck,WA 98380
& Parking in
'1 APDdesignsC,icloud.com
Applicant Info:
Robert Satran
E Kimberley Dr
Rd Easement Belfair
to Kimberly Dr
el 305' el 298' #123303290263
190'
Date:
LEGEND Datum NAD83 '//15/2025
Page
Bench Mark
soil log
— Property Line Scale
-• -• Power Line I 1" _30'
' Not A survey ---- Water line
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