HomeMy WebLinkAboutSWG2024-00478 - SWG As-Built - 4/15/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
Permit Number SWG 2024-00478 Parcel# 22331-52-00005
Applicant Name Braulio Arroyo Subdivision (Name/Div/Block/Lot)
Applicant Address 5258 S 212th St
City, State, Zip Kent,WA 98032 Installer Name Jose Ramirez
Site Address 471 NE Collins Lake Dr Designer Name Rod Left UI 3;INSTAt,LAT[Ot�I EHECK�IST � ti
rv, Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pressure pretreatment Type
>5ft.fromfoundation? ------------- - -- - ❑ NIA ❑■ YES ❑ NO
>50ft.from wells? --------- - -- -- - - ❑ ❑■ El
>50 ft.from surface water? -- -- - - - ❑ W El
Cleanout between building and tank? - -- �-�-El-- ❑ ❑■ ❑
5 v ; Tank baffles present? --- -------\\ ç _ %-- - ---- iii ❑
fir)
24" access risers over each compartmen ---- - - - El ❑■ El
U1 Effluent filter installed?--------- - -- -- - -- ---- ❑ 0. ❑
Septic tank size 1500 gal - �. anufacturer Hagerman
a3 D-box water level and speed levelers used? ------ --------- ® NSA ❑YES ❑ NO
Manifold/D-box accessible from surface? --------- ----- -- ❑ ❑
mzCheckvalvesinstalled? ------- ---- - ------- ----- - - ❑ El 0
�C1Q,
Transport Line Size 2 inches Schedule/Class 40
s 3-1 Bedrooms installed (check one) ❑ 2 ❑3 0 4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.fromfoundation?-- -- -- - ---- - ---- --------- ❑ NSA DYES ❑ NO
. >100ft.fromwells?------------- ------ ---------- ❑ 0 ❑
>100ft.from surface water?---- ---------- ------ ---- ❑ ❑■ ❑
1>10ft.frompotablewaterlines?------------ ------ ---- ❑ 0 ❑
5ft.frompropertylinesandeasements?------- -- ----- -- El 0 El
>30 ft from downgradient curtain/foundation drains?--- - -- --- - - O El
Drainfield level and observation ports present ---- - -- - ------ ❑ 0 ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?------ --------- - --- ❑ �' El
Pump tank setbacks consistant with septic tank?------------- O N/A 0 YES ❑ NO
} I
Pump tank size 1500 gal Manufacturer Hagerman
� - ---- ❑ ® El
24 access riser(s)and accessible from surface?------ --
Alarm or Control Panel Installed? ---- ----- - ----------- ❑ ® El
;ray
Control Panel equipped with Timer!ETM/Counter ----- ----- ❑ 0 El
Pump installed in 0 Bucket or ❑ On Block or ❑ Other
Pump Make/Model Liberty FL5114 ■ Floats or El Transducer
Tank draw down 2 in/min Pump capacity 64 gpm Squirt Height +6 ft
Pump on time 37.5 sec Pump off time 2 hr Daily flow set at 480 gpd
Updated 821!2018
t 1
Mason County OSS Installation Report pg. 2 i Pardel# 1 62 0000 5
ABANDONMENT'RECORD
Were existing septic components abandoned as part of this•prof ct? ----- ______
- :2] yes [ Ko:
If yes,please describe:5Q'Q�,( � CA`l�K\its9 0.11 4 Sf
Were all,components.pumped out and properly abandoned per V,,'Ac246-272A-0300?.------- �1 YES. O,NO
RECORD DRAWING
This is a pennanentrecorii and must be accurate and descriptive enough to re-lgcate in.the need of maintenance activities and future�develbpment Typical Record
Drawings contain: DraiMlel{i&:mahiiold orientation&layout,Septidpusp.tank IocattonNorth-IrroW,teserve•drainfield;existing and propbsed'buildingsrlocalbn orwells,waterlines
wells;obse vtllonports,cleanauts,and otherinaintenance access.points:Incomplete Recbrd Drawings may-create additional delays in final lnstallatbn approval-and'related permits,
I jj
Record Drawil0 Attached-
G
ERTIFICA`l'10N'OF1INSTALLATION
INSTALLER
DESIGNER/ENGINEER
[certify that 1 installed the system in accordance with is certify that the system has been installed in actor-
'the septic design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED"by
County Public Health and that any deviations showh Mason County Public Health and that any deviations l'
here have been cleared/approved by both the designer siho.wn here have been.Cleared/approved byboth F`
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Meson County Codes: 'Mate and Mason County Codes
I further certify that all information contained on this 11further certify that all information contained on this
form anit; ac d Record Drawing is atccurate. form and attached Record Drawing is accurate;
S1 atur .of Installer bate
Printed Name of Signee. - /1 1 -
MASON COUNTY PUBLIC'NEALT-H `��?,�
The undersigned approves this installat on,Rep rfid� >-i °
/ :r 41 teF
Record Drawing on beh6i ason C u lit r trCENs oes�oNeR i
Health, ✓✓ EXPIRES 21161
COUP✓Tli'iV ry 200`6
Signature pfErivironmenta(Health Specialist. )Date „,
r;1• .(stamp;signature and date)
THIS FORM MAY SCANNEdAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
WATER LINE DISCLAIMER:
ffYE!RWZRf SM1114'NRt0YOS➢pVflfl0E EA6Efl
RS IOR;REIOUI®RHINIYRW0.4HONFOSEA
OONSUUFSNL08' t.LEESPOASONY
LICENS NER
EXPIRES 12 H51�
A6
y9.
\ A:Ia
425'
SnOPELINE
s1 g3 PARCY
2 00004 a
APR 15 2026
JASON COUNTY ENVIRONMENTAI HEALTH
430'
A aE Sys
435' �owQ
�yo� ER HOUSE RECORD OF CONSTRUCTION
2
445' a PANEL THIS IS NOT A SURVEY.ALL PROPERTY LINES/BOUNDARIES HAVE
000 BEEN DEMONSTRATED BY THE OWNER(S)AND/OR THEIR AGENT(S).
450' `Err4
•ALL MEASUREMENTS WERE TAKEN FROM KNOWN POINTS DEMONSTRATED BY THE PROPERTY OWNER.
ALL MEASUREMENTS WERE TAKEN WITH AN OPEN-REEL FIBERGLASS TAPE MEASURE.
455' Qp: ;%' •NO FOUNDATION SPOILS OR BURNING ON DRAINFIELD AREAS.
%! DUE TO UNFORESEEN WATER TABLES,A CURTAIN DRAIN MAY BE REQUIRED.
_ O>'' •DIRECT ALL DOWNSPOUT/SURFACE WATER AWAY FROM DRAINFIELD AREAS.
...�LC.;���!-,;•�; � •ALL TANK ACCESS COVERS ARE RISERED TO FINISHED GRADE.
LEGEND 485 ZOE AC M E D ES I G N
A0 ;•.�i�,. � �SOIL LOO
' ---. _NO 6UIL0
- _ O CLEARIN 3 LIMITS DATE- 2 APR 2026 P0 BOX W ARPAS
54
e` : �� OIA NAME- ARROYO SILVERDALE,TREES�12"
+Q =CLEAN OUT 98383
.' 0.5.10' 30' 50' T5' 100' TAX ID- 22331-52-00005
0- =1500-GAL SEPTIC TANK
aQ =1500-GAL PUMP TANK STREET- 471 NE COLLINS LAKE DR TEL.360-698-8488
SCALE(FEET) ® =SPLITTER SCALE: 1"=40' ROC INFO@ACMESEPTIC.COM