HomeMy WebLinkAboutSWG2026-00015 - SWG As-Built - 4/30/2026 ;Docusig 4 Envelope ID:58613BC0-3D66-404D-A0CF-042E391 D3B47
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
= APPLICANT! PERMIT INFORMATION
Permit Number SWG SWG2026-00015 Parcel # 320065002041
Applicant Name RARRARA HOA( Subdivision (Name/Div/Block/Lot)
Applicant Address 15gn F ISI ANr) I AKF r)R ISLAND LAKE SHORELANDS BLK: 2 LOTS: 41 &42
City, State, Zip SHF- TON, WA 98584 Installer Name Logan Spear
Site Address Same as Mailing Designer Name Micah Halverson
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type ravityRerI Pretreatment TypeSeptic Tank
>5ft. from foundation? -- - - - - - - - - - - --- --�- - - ❑ N/A ®YES ❑ No
>50ft. fromwells? - - - - - - - - - - - ❑ ® ❑
>50ft. fromsurfacewater? -- - - - - -'� ,'r .JL? - - - ❑ ❑ ❑
Q Cleanout between building and tank? -- -
Tankbafflespresent? - - - - - - - - - - ---- ------ - - -- - --- - - 0 ® ❑
24"access risers over each compartment?- - - - - - - - - - - 0 Q ❑
W Efuent filter installed?- - - - - - - -- - -- ❑ ® ❑
Septic tank capacity (working) 1250 gal Manufacturer Sound Placement
D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A ® YES ❑ NO
J,
O Manifold/D-box accessible from surface?- - -- - - - - - - - - - - - - - ❑ ® ❑
;O:LL
.Z : Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ IZI
Transport Line Size 4" Schedule/Class ASTM 3034
Bedrooms installed (check one) ❑ 2 ❑3 E14 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - - - - - - - - - - - ' 6 [O[j ® YEs ❑ NO
>100ft. fromwells?- - - - - - - --- - - - -- - - - �- ?�� ` ' ® ❑
>100ft. fromsurface - - - - - - -
water? -L - -AP 3-s 26-25 ❑ 4'_ ® ❑
W - �
LL >10 ft. from potable water lines?- - - - - - - �As0 E;@u NVIR0NMENTAL ❑Z > 5 ft. from property lines and easements?-- - -- - - - - ALTH ® ❑
> 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ❑ ❑
..:;
Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ X❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed overdrainfield?-- - - - - - --- - - - - - - - - - ❑ ® ❑
= Pump tank setbacks consistent with septic tank?-- -- -- - - -- -- - ® N/A ❑ YES ❑ NO
1` Pump tank capacity (flood) gal Manufacturer
24" access riser(s) and accessible from surface?- - - -- - - ----- - ❑ ❑ ❑
AlarmorControlPanelInstalled? - - - -- - - - - - - - - - - - - - - - - ❑ ❑ ❑
Control Panel equipped with Timer!ETM/Counter - - - - - - - - - - ❑ ❑ ❑
Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
Pump Make/Model ❑ Floats or ❑ Transducer•a..
Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 8/2112018
,Docusig,,Envelope ID:58613BC0-3D66-404D-A0CF-042E391 D3B47
Mason County OSS Installation Report pg. 2 Parcel# 320065002041
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - - - - - - - -- - -- ® YES NO
If yes, please describe:In talled naw frainfielri
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - -- ® YES NO
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: Dralnfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfleld,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.
Initial l
Owners Initial: I/ q MgSoNCOUNTy
�HFq�Ty
® Record Drawing Attached
CERTIFICATION OF INSTALLATION
ry
INSTALLER DESIGNER/ENGINEER
/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 I further certify that all information contained on this
f u q,attached Record Drawing is accurate. form and attached Record Drawing is accurate.
Lo SF
Signature of Installer Date
Spear
Prriinnted Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Recor awin g on behalf of Mason County Public titataw
Hea the -
oil
-3 1`Lt� S:09116E T
Sign ur of n ironmental Health 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
Docusign Envelope ID:58613BC0-3D66-404D-A0CF-042E39l D3B47
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Edge of Deck j 3 7 r-
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Existing Septic Tan ':�},;;. :{:`''`
And Seepage Pit / + J o0
Approved 7/61k / \
/ 1 2 Approximate Land Size• .73 Ac i ` Z
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a Owner/// }� } MASON COUNTY ENVIRONMENTAL HEALTh Applicant:
/ APR 3
, , ,i 240'+/- %' # CALLOUTS J . O
T
1) Existing 500 gal Single Compartment Septic Tank / J I!) C.
V i �qss 2 4"ASTM3034 with Cleanout 5 1 M C Cn O
�� P� 3) New 1200gal 2Compartment Septic Tank o
f� s i 'w:tey; 4) Parking Pad I .N p
i ne 4"ASTM3034 to D-Box i N 0
)
i ----� 6) D-Box Access i r1 tm
Well 7) Observation ports per Design i
8) Drainfield pipe Inspection Ports
This is not a suNeu@
I I L LOv
This Asbuilt Drawing is intended for the purpose of I 1640 E IslandLake Dr I O �—
locating and maintaining the septic system on this parcel. I _ x ai
Measurements and distances are approximate. I Initial Initial (. m j
It is advised by septic designer Micah Halverson
to use a licensed surveyor to determine lot lines, �� � d _
301 201 0' 10' 20' 301
elevations,topography and to provide a legal site plan.
Owner is responsible for establishing all property lines, Scale: 1"=20'
easements and/or right-of-ways. /
Infection Date 4/14/2026