HomeMy WebLinkAboutSWG2025-00438 - SWG As-Built - 4/30/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPI ICANTI PERMIT INFORMATION
Permit Number SWG 2025-00438 Parcel# 42216-50-00083
Applicant Name Dawn Treader Investments, LLC Subdivision (Name/Div/Block/Lot)
Applicant Address 517 96th Ln SE LAKE CUSHMAN#9 TR 83
City, State, Zip Olympia,WA 98501 Installer Name House Brothers Construction
Site Address 171 N Kokanee Cove Way Designer Name Arrow Septic Designs, Inc
.y Y
INSTALLATION;CHECKLIST
Full System
V
® Installation ❑Tank(s)Only ❑ Drainfield Only Repair ❑Other
System Type Sand-lined Pressure Bed Pretreatment Type
>5ft. fromfoundation? -- ---- - - - - ---- - - - - - N/A DYES O N
>50ft.fromwells? - - - - - - - - - - - -- - - - - - -� - ❑ ❑
,, >50ft.fromsurfacewater? - - - - - - - - - - � - - -t - ❑ 0 ❑
Cleanout between building and tank? - -- ? �-�`® - - - - ❑� ❑
Tankbafflespresent? - - - --- - - - v - - ®- -- - ❑ 0 ❑
24" access risers over each compartment -��- - - -\-)) - ❑ ❑■ ❑
W Effluent filter installed?- - --- - - ---- \\ - - - ❑ II ❑
Septic tank capacity (working) 1 250 `J nufacturer HB Precast
Q:' D-box water level and speed levelers used? ---- - ----- - - - - ❑ N/A ❑ YES f NO
�O. Manifold/D-box accessible from surface?- - -- - -- - - - - - - - - -- ❑ ❑ ii
Checkvalvesinstalled? - - - - - - - -- -- -- - - - - -- - - - - - ❑ III ❑
2: Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed (checkone) ❑ 2 Q 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.fromfoundation?- - - - - - - --- - - - - - - - -- - - - - - - - ❑ N/A EUYES ❑ NO
a >100ft.fromwells?------ - - - -- - ---- - - - - ---- - -- - ❑ El ❑
--a ? >100ft. fromsurfacewater? - - - - - ---- - ------ - - - -- - ❑ II ❑
Id.t
>10ft.frompotablewaterlines?- --- -- - -- - - - - ----- - - - -
> 5ft from property lines and easements?- - -- - - - - - - -- - - - - ❑ 0 ❑
> 30 ft from downgradient curtain/foundation drains?- - - - - - - - - - O ® ❑
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?-- ---- - --- - -- O N/A YES ❑ NO
Pump tank capacity(flood) 1,200 gal Manufacturer HB Precast
24" access riser(s) and accessible from surface?--- --- --- - - -- ❑ II ❑
Alarm or Control Panel Installed? - - -- - - - - --- - - -- - - - - ❑ ® ❑
Lis I
Control Panel equipped with Timer I ETM/Counter - - - - - - - - -- ❑ ® ❑
Pump installed in ❑ Bucket or ❑Q On Block or ❑ Other
Pump Make/Model Liberty 290 II Floats or ❑ Transducer
L3.
Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 5.5 ft
Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd
Updated 8/2V2018
Mason County OSS Installation Report pg. 2 Parcel# 4 ZZl(a.50" ec 8
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -------------- - ® YES NO
If yes, please describe: t)u- ' yZ XL"r`r"' "'t`- 1F Oc A
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 relocate 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/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 a/i-information contained on this' I further certify that all inforrratior contained_nn_fhis
form a,,i4 attac /d Record Drawing is accurate. form and attached Record Drawing is accurate.
Signat re ofInstaller Date
Printed Name of Signee '
o• �
MASON COUNTY PUBLIC HEALTH d
The undersigned approves this Insta9/ ion Report ''
Record Dra ing on behalf of Mason Co fifty ublic r 0
c.
U/y 0 PAULA JOY JOHNSON C
Health: Tl'Fiy�/RO ?G •L'tCi�+l;;E •ULSI't�iVE�d.. 1
41 REs I -
Sigma re of Environmental Health Specialist Date �T// (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
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