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Home My WebLink AboutSWG2026-00009 - SWG As-Built - 4/23/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2 oZ('—D000 Parcel# (Z 1 O5r-5) — 0)OZ Lp Applicant Name $2 c. - EVUG'T Subdivision (Name/Div/Block/Lot) Applicant Address j(D o c dco t t Oye City, State, Zip C.1t\f� h/A Installer Name Koy1 Site Address lop P - Designer Name Akc P95 �e INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type r Pretreatment Type >5 ft.from foundation? -- NIA /:tYC '❑YES 'No >50ft.fromwells? --- �- '- I ® ❑ Z' V Y +>50 ft.from surface water? --- - -- ,t Q ' Cleanout between building and tank? U --�--- z-2026-- - O ® O 3y' V Tank baffles present? --------- ❑ ® ❑ 24"access risers over each compact et1 C --- ❑ J ❑ W ' Effluentfilterinstalled?------ --------------- Septic tank capacity(working) 2I1' ' boa gal Manufacturer h •c t' O D-box water level and speed levelers used? - -------------- `❑NIA ❑YES NO DJi O Manifold/D-box accessible from surface?---- --------- ---- ❑ ❑ ❑ mZ Check valves installed? ------------ -- ----- - -- ---- ❑ ❑ ❑ OQ , 2 Transport Line Size 1rr Schedule/Class ScJ14f 0 Bedrooms installed(check one) 02 I1 4 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?------ ------ ---- ----- ON►A DYES 7NOr4 0 >100ft.fromwells?------------------ ----------- ❑ W >100ft.fromsurfacewater? ------- ---- ------------- ❑ ® ❑ iZ ; >10ft.frompotablewaterlines?---------------------- El ? >5ft.frompropertylinesandeasements?------- ---- - -- -- Q WVgtyii' ❑ >30 ft.from downgradient curtain/foundation drains?- ---- -- - -- ❑ ® ❑ Drainfield level and observation ports present ---- - - -- - ----- ❑ ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ ❑ Pump tank setbacks consistent with septic tank?--------- --- ❑ NIA ® YES ❑ NO Pump tank capacity(flood) 4250 gal Manufacturer hatgg, 24"access riser(s)and accessible from surface? ------------ ❑ ® ❑ IZ Alarm.or Control Panel Installed? ------ ------------.--- ❑ El JControl Panel equipped with Timer I ETM I Counter --- - -- --- ❑ ® ❑ Pump installed in ® Bucket or ❑ On Block or ❑ Other IPump Make/Model �,�{ I -Floats or ❑ Transducer Tank draw down in/min Pump capacity 148 9pm Squirt Height ft Pump on time I. 5na Pump off time Daily flow set at 2 7' gpd Updated 812112018 ; 1 Mason County OSS Installation Report pg. 2 Parcel# )Z► OS ,S l— cal 0 2-L ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- YES ❑ NO If yes, please describe: f e-in O\/C_- inl lira l-r v,k 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: 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. 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 !further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of lnst Date Printed Narde of signee I 2of Z MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public r Health: f icuwJ 4Fl -3h6 Signature of Environmental alth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 • H 1101 ± DETROIT DRIVE EDGE DGE OF PAVEMENT APPROX. WATERLINE +I O o GARAGE HOME N BELOW (2 BEDROOM) 22' NUWATER& PUMP TANK 622;� p ADU 10, s �1 BEDROOM) O B (1 �2 # a rr:t 21 O 12 . 0 ©_ I SHED i µ �rwrwwrrMrwwa�we; NEW 4 BEDROOM D/F A P P ®p p PRIMARY & RESERVE DOWNSPOUTS RUNOFF APR 232026 MASON COUNTY ENVIRONMENTAL H€AMTH Q = CLEAN0UT PROJECT SUMMARY: RE © = CONTROL PANEL REPLACE EXISTING TANK& DRAINFIELD W/ NEW 3 BEDROOM OSS (NUWATER, �o!Asq�J PIT& PRESS. DRAINFIELD). 7 ��"e�; 4 39 �� bj� 5110393 2 ALEX L.PAYUSE $ 7��II�,��q 7f}LJ�J /}//{\,``�,j[\\y/ggq77'{�I��II�n\\Vgpl LICENSED DESIGNER Jl\EC®RD D A V V J VG EXPIRES CUSTOMER: RICK FOUCHT TEST HOLE 1 TEST HOLE 2 TEST HOLE 3 N 0-40 GSL 0--28 GSL 0--25 GSL ( n� ".........••........I-........ PARCEL: 1 2 1 0 5 - 5 1 - 0 1 0 2 6 H2O @ 40 H2O @ 28 25-35 MOTT. ALPINE SEPTIC SITE: 100 E DETROIT DRIVE ROOTS-40 ROOTS-28 H2O@35 -DESIGN- ROOTS-25 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,OWNER-PROVIDED INFORMATION,FIELD MEASUREMENTS&COUNTY GIS. DESIGN INTENDED FOR GRAPEVIEW WA 98546 I SEPTIC PURPOSES ONLY. PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER DEPARTMENT/AGENCY 360-507-1546 10 10.5 Ii 12. REVIEW.DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS.