HomeMy WebLinkAboutSWF2024-00301 - SWG As-Built - 3/4/2026 Docusign Envelope ID:31 B28E73-B650-41 A0-AAEA-33E4CDA34213
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION.
Permit Number SWG 2024-00301 Parcel # 42132-31-00060
Applicant Name BANNING, DONALD S Subdivision (Name/Div/Block/Lot)
Applicant Address PO BOX 401 N1/2 SE NE SW
City, State, Zip LITTLEROCK, WA 98556 Installer Name 3ami a workman
Site Address 131 W BEAR GRASS LN Designer Name Micah Halverson
INSTALLATION CHECKLIST ' _.
El Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type sand Augmented Bed Pretreatment Type Septic Tank
>5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
>50 ft. from wells? - L 1i`-i � r` 0 x❑ El
Z >50 ft. from surface water? - -�,� ❑ x❑ ❑
ii.:_t_ between building and tank? --- Ti-f!- -FEB-2-3 292-- - ❑ 0 ❑
✓ Tank baffles present? - t- - 0 x❑ ❑
F- 24"access risers over each compartment. fy_ - El ElW Effluent filter installed?- — - El x❑ ❑
cn
Septic tank capacity (working) 1500 gal Manufacturer sound P1 acement
i7 D-box water level and speed levelers used? - - ❑ N/A El YES x❑ NO
DO,. Manifold/D-box accessible from surface?- - O El E
u.
_ODE Check valves installed? - - 0 ❑ x❑
oa_
2 Transport Line Size 2" Schedule/Class sch40
Bedrooms installed (check one) 0 2 El 3 0 4 ❑ 5 ❑6 El Commercial/Other
>10 ft. from foundation?- - ❑ N/A x❑ YES ❑ NO
O >100 ft. from wells?- - El x❑ El
11.1 >100 ft. from surface water? - - El El El
u. >10 ft. from potable water lines?- - ❑ x❑ El
aZa > 5 ft. from property lines and easements?- - 0 0 0
Q > 30 ft. from downgradient curtain/foundation drains? - - 0 ® ❑
Drainfield level and observation ports present - - El 0 0
El Graveless chambers or ® Clean gravel used? (check one)
• Proper cover installed over drainfield?- - 0 x❑ ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A x❑ YES El NO
ZPump tank capacity(flood) 1585 gal Manufacturer Sound Placement
< 24"access riser(s)and accessible from surface?- - 0 ® ❑
aAlarm or Control Panel Installed? - - O x❑ 0
2 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 El
n
a- Pump installed in ❑ Bucket or ❑ On Block or 0 Other orenco EZ Pack
1' Pump Make/Model Orenco 5005 x❑ Floats or 0 Transducer
a Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 10 ft
Pump on time 30 sec Pump off time 1:19hr Daily flow set at 450 gpd
Updated 8/21/2018
Docusign Envelope ID:31B28E73-B650-41A0-AAEA-33E4CDA34213
A
Mason County OSS Installation Report pg. 2 Parcel# 42132-31-00060
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - E3 YES 0 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES 0 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,North 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.
owners Initial : [__lflhtlal
0 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
I further certify that all information contained on this 1 further certify that all information contained on this
wag; ,attached Record Drawing is accurate. form and attached Record Drawing is accurate.
2/22/2026
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Signature of Installer Date 2 ,.
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Jamie Workman 4 �1.
Printed Name of Signee �11 y•
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MASON COUNTY PUBLIC HEALTp y - i.%
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IIIIThe undersigned approves this Installation epo}7 • 1
Record Drawing on behalf of Mason County Public LTHANIEL5
HN-vI-m owil
Health: ,yj �R ' LICENSED DESIGNER
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S7oN p�N�E 20?6 exw c-ofyisti
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Signature of Environmental Health Specialist I4./VIA//.‘="s4(7-4, (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
Docusign Envelope ID:31B28E73-B650-41A0-AAEA-33E4CDA34213
. ti //�\� BEDROOM T `�I®T I SWG2024-00301
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Property Line Established By Other I 655'+/- O
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104' - O
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Sweep Access This end -� ■ CO
SP I� veep Port Inspection
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CALLOUTS
'6 124'
DP Shallow port Inspection I I
1) Sewer Cleanout
2) 1500 Gal. 2 Compartment Septic Tank cu
3) 1500 Gal. Pump Chamber
4) Orenco MVP Control Panel `5
+ Approximate Land Si7P. 5Ac., 5) 2" Sch 40 Effluent Transport Line Er, I b I
m 6) 10'X48' Sand Augmented Bed Q. a~
7) 10'X48' Reserve Bed L5
8) Waterlines v Cl)2 .ao IP0 I CD co
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.0 i I BLD2025-01018 i — Driveway I r
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D- Intial - \� ‘�
Y Initial A NNCl4NTSi 1OO4O9 ALVr:R$QA1 f 1 / `��� O \
VED r LICENSED DESIGNER �, o•
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Two-Party oo
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BAR ?D�6 ExPIRES: 11st Nell _I o c o) o
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0' 25' 50' 100' 150' \
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This is not a survey: a, �
Scale:1"=50' N.
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This Asbuilt Drawing is intended for the purpose of lr \ " to -O
locating and maintaining the septic system on this parcel. / r p
Measurements and distances are approximate. ; / > ' N
It is advised by septic designer Micah HalversonA N ' / w m >
to use a licensed surveyor to determine lot lines, \ /
elevations,topography and to provide a legal site plan. a =
Owner is responsible for establishing all property lines, \ __ _
easements and/or right-of-ways. `' _-- /
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Inspection Date'2/72/2026