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Home My WebLink AboutSWG2026-00067 TANK ONLY - SWG As-Built - 4/30/2026 Docu�o Envelope ID:32B8BEE9-F7D6-8B7E-8265-F99D9784F25E Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG SWG2026-00067 Parcel# 32127-50-00030 Applicant Name RIJRC=,FS$ MIc:HAFI .1 Subdivision (Name/Div/Block/Lot) Applicant Address 1701 137th street south I AKF I IMFRICK 1 10T• 30 City, State, Zip Tacoma WA 98444 Installer Name Jamie Workman Site Address 551 F BALLANTRAE DR Designer Name Micah Halverson INSTALLATION CHECKLIST ❑ Full System Installation ®Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type tment Type Septic Tank >5 ft. from foundation? - --- - --- - - - - ❑ N/A EYES ❑ NO >50ft. fromwells? - -- -- - - - - - - - - - - ❑ ® ❑ • Z. >50ft. fromsurfacewater? - - -- - - - - - - - - - - - ® ❑ HCleanout between building and tank? -- - _\- ,-- ---_1� -- ® ❑ C) Tankbafespresent? - - - - - - - - - - - - - - - - - - - ® ❑ 24"access risers over each compartment?- -:- - - - - - -- - ❑ x❑ ❑ a W - Effluent filter installed?- -- - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ Septic tank capacity (working) 1070 gal Manufacturer Infiltrator D-box water level and speed levelers used? - - - - - - - - - - - - -- - ❑ N/A ® YES ❑ NO' Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - O ❑ ❑ O1.2 Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ 2 , Transport Line Size 4,, Schedule/Class ASTM 3034 Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. fromfoundation?-- - - - - - --- - - - - - - - - - 1" ` x-�' ❑ N/A DYES 0 N >100ft. fromwells?--- -- - -- ---- >100 ft. from surface water? - - -- -- - " :u.. >10 ft. from potablewater lines?- - - - =5: - ) --' S - �❑- --- H ❑ ❑ Z > 5 ft. from property lines and Basemen? �MENIPL- E� > 30 ft. from downgradient curtain/foundi ns?- j �, - - - ❑ ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑ ❑ • ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed overdrainfield?- -- - -- - - - - -- - - ---- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?---- ------ --- ❑ N/A ❑ YES ❑ NO ZPump tank capacity (flood) gal Manufacturer 24"access riser(s) and accessible from surface?- - - - -- ----- -- ❑ ❑ ❑ Alarm or Control Panel Installed? - - - - - - - -- -- - -- -- -- --- ❑ ❑ ❑ 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 Docu`:y Envelope ID:32B8BEE9-F7D6-8B7E-8265-F99D9784F25E Mason County 0SS Installation Report pg. 2 Parcel# 32127-50-00030 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ------- -- --- - - - ® YES NO If yes, please describe:Pumped and installed new tank in same location of old tank 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. initial Owners Initial: " .; APR 302, 26 a °,26 MASON COUNTY ENvIRON, ii1�NTAL HEJtg ALTN ® 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 I further certify that all information contained on this f gi ,gt Ached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of Installer Date ,bo Jamie Workman �y� Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and i g S4QpfQ9 Record Drawing on behalf of Mason County Public Health: -1�3��(� di?FRES•DAftfiC Signature f r mental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121/2018 Docusl'-Envelope ID:32B8BEE9-F7D6-8B7E-8265-F99D9784F25E x 2 BEDROOM TANK REPLACEMENT ASBLIILT SWG2026-00067 W p Lot 29 O O O U O W O J y ao W N - - - - - - Water r - - - - - - - - - - - - - - - - - - - - Meter c *k .J a c0i m W Approximate LLoLa 4 Size 24 Ac 1 a sF Existing Driveway EXISTING GBLN I TH1 I I 0-24"65L I + AY . I 24"Bottom of Test hole I I � �00� 5 r O Properly Lines Established By Other .Ny'F.dyyYw`P../uY N 1 12 +1- Owner/ c� A licant: h Z Fr , \ O CALLOUTS t� 1) Sewer Cleanout �I' ' 4 V 2) New Infiltrator 1060 2 Compartment Septic Tank —J oo O 3) D-Box Access Lot 30 4) Existing Drainfield Trenches 5100408 MASON COUNTY ENVIR0N � � � O Permit#8917 MENTAL Hi ALTH 4— �, LtCCecN9ED lf3t>EFt 5)Assumed Waterline s .in o N c 0 This is not a sulvei : This Asbuilt Drawing is intended for the purpose of O U) locating and maintaining the septic system on this parcel. i Measurements and distances are approximate. O o It is advised by septic designer Micah Halverson Initial Initial > X 0 to use a licensed surveyor to determine lot lines, I � � m > elevations,topography and to provide a legal site plan. Owner Is responsible for establishing all property lines, I = a 2 easements and/or right-of-ways. 30' 20' 0' 10` 20' 30' Inspection Date: 4/01/2026 Scale: 1"=20'