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Home My WebLink AboutSWG2025-00474 - SWG As-Built - 5/14/2026 Mason County 0SS Installation Report P pg. 1 MASON COUNTY PUBLIC HEALTH ARPLICANT/:PERMIT:INFORMATION: Permit Number SWG 2025-00474 Parcel# 12232-10-001130 Applicant Name MICHAEL OMURA Subdivision (Name/Div/Block/Lot) Applicant Address 4327 NE 60TH City, State,Zip SEATTLE WA. 98115 Installer Name SCHOENING EXCAVATION Site Address 6472 E GRAPEVIEW LOOP RD Designer Name CINDY WAITE INSTALLATION CHECKLIST_ Full System Installation ❑Tank(s)Only rainfield Only ❑Repair ❑Other System Type PRESSOR ere ment Type BNR 500 foundation? -------- % % --__ _ _ >50ft.fromwells? ----_ ❑NIA ®YES ❑ NO r f >50 ft.from surface water? ---------\ ----- . $-- ❑ Cleanout between building and tank? - _� _ -- Tank baffles present? --__________ - ❑ if 24"access risers over each compartment?- g__ ___ ❑ "W Effluent filter installed?- - ❑ ® ❑ x A. Septic tank capacity(working) /o, Baal Manufacturer �!� �,,�,, ❑ D-box water level and speed levelers used? -----_ _ __ X07 Manifold/D-box accessible from surface?. -------- ® NIA ❑YES ❑ NO Check valves Installed? ---_________ - A,t` Transport Line Size 2 Schedule/Class SCHEDULE 40 Bedrooms installed(check one) Q 2 ❑3 04 ❑ g ❑6 >10 ft.from foundation?-------------------------- O -_____ ❑Commercial/Other =:p >100ft.fromwells?•---------------------------- >100 ---------- ❑ NIA mYES ❑ No gal ft.from surface water?. ❑ ® ❑ >10ft.fromlines?- ----------------------- ❑ jK potable water lines ------- - ❑ > 0fffroproperty easements?------------------- lines and - >30 ft.from downgradient curtalnffou ndation drains?- ' Drainfield level and observation ports present -------------- _ ❑ ❑ ❑ Graveless chambers or Clean gravel used? (check one) Proper cover installed over drainfield?---- Pump tank setbacks consistent with septic tank?------------ • - ❑ NIA Ii YES ❑ NO r Y Pump tank capacity(flood) 145_5 gal Manufacturer HAGERMAN 12 S'p 24"access riser(s)and accessible from surface?------------- O c ----------- 0 Alarm or Control Panel Installed?- Control Panel equipped with Timer/ETM/Counter----------- ® ❑ ® ❑ Pump installed in ❑ Bucket or �$"On Block or ❑ Other tL Pump Make/Model ❑Floats or ®Transducer Tank draw down 1.5 In/min Pump capacity >J pm . Squirt Height ft Pump on time Ln,M / Pump off time 4 Daily flow set at O gpd }} 5 �/ 1 f�'C/is o 60/ii2* '�7 61 11 -0 Updated 812112018 � ,+O ' f10 .ter r, .— L/L.r3- 1 `Th Z) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT.INFORMATION Permit Number SWG 2D15-v 0474 Parcel# X22 32-to= o t3c, Applicant Name r A o Subdivision (Name/Div/Block/Lot) Applicant Address Q.3Z..-r NE by fit, City, State, Zip I , WA q,$tt Installer Name ►c>ey�ih E vaMvi IL Site Address q- 10 L, Designer Name Wack INSTALLATION CHECKLIST [Full System Installation ❑Tank(s)Only ❑Drainfield Only [Repair ❑Other System Type_ U '€. Pretreatment Type_ j . 5aD Ca wubtc l >5 ft.from foundation? - - - ------- -- ❑ NIA YES ❑ NO >50 ft.from wells? - - - --- ---- - - --- - ------- - -- --_ ❑ � ❑ Y >50 ft.from surface water? - - - - - - ---- - / FQ. Cleanout between building and tank? ------------ ---- --_ 0 V ,Tank bafflespresent? - - _ - _- _ _ - - __ ,_.,/ ❑ 24"access risers over each compartment?-------------- - - ❑ I!( ❑ W Effluent filter installed?- [ ❑ Septic tank capacity(working) 100 0 gal Manufacturer -� �10 D-box water level and speed levelers used? - -- - - - -------- - Lf"y NSA ❑YES ❑ NO 0 Manifold/D-box accessible from surface?--------- - - ----- - ❑ mz ; Check valves installed? - - - - - - - -- - - - - - -- -- - - - - -- - ❑ Transport Line Size 2 u Schedule/Class ar'Cr 4o Bedrooms installed(check one) 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Ot er >10 ft.from foundation?- -- - ---- - - - --- - - ------ ---- ❑ N/A YES ❑ NO >100ft.fromwells?- --- - -------- -- ------------ -- ❑ [ ❑ J >100 ft.from surface water? - >10 ft.from potable water lines? ------ ____ _ ❑ ❑ QZ >5 ft.from property lines and easements?- - ❑>30 ft.from downgradient curtain/foundation drains?-- - - - -- - - _ 0 ❑ ❑ Drainfield level and observation ports present -- - - -------- -- ❑ L1 ❑ ❑ Graveless chambers or [4 Clean gravel used? (check one) Proper cover installed over drainfield?-- -- -------- - --- --- ❑ LvJ ❑ Pump tank setbacks consistent with septic tank?------------ . ❑ NIA YES ❑ NO Pump tank capacity(flood) 1455 gal Manufacturer 24"access riser(s)and accessible from surface?---- --- --- --_ ❑ ❑ a �Alarm or Control Panel Installed? -------- - ----------- - Control Panel equipped with Timer/ETM/Counter - ---- - - - - - ❑ ❑ Pump installed in ❑ Bucket or On Block or ❑ Other Pump Make/Model L L 41f 2$0 ❑ Floats or Transducer I ` Pump ca Tank draw down I.S in/min 0. capacity ty 40 gpm Squirt Height '3•b ft Pump on time 1 mth l4ec.. Pump off time (o t trs Daily flow set at 1' 0 opd Updated 8121!2018 Mason County OSS Installation Report pg.2 Parcel# 12232-1O-001130 12232-10-001130 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- If yea,please describe: ❑ YES ® NO Were all components pumped out and properly abandoned per WAC246-272A-030o?-------- 0 S III NO RECORD DRAWING Whls Iii pelminent raaard and must bs aceuate and dssadptiva snouph to ndaeats in eha and of matmsnsnes aefvldes and rosin Draw ng.contin DtalMsld amu,ifold odentadon a layout,fiepHWump tank location,Na th arrow,reserve dmioreid, atopm o1 rypi®I Record well.,o�arvagon polls deanouts,and otter maiNanmsee accesa point In eldstinp and proposed b aHaiJa lcesQatt o4 d related a pencils.wmp(ete R=d Drmsings may riotaddiffWal dobp in final Instal"M epX=and rtftd p&W& .,-p, s��p,..� bx It'v , I��t� scyv eea ll d v p , ,n is a. L1 A4 PR /�� ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI ENGINEER 1 certify that I installed the system In accordance with I certify that the system has been installed in eccor- the septic design stamped'APPROVED"by Mason dance with the septic design stamped`APPROVED"by County Public Health and that any deviations shown Mason here have been cleared/approved by both the designer shown here have been ty Public cleared/approved th and that yebo�ns 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 lnfonnatlon contained on this I further certify that all information contained on this form and attached Record Drawing is accurate, form and attached Record Drawing is accurate. Signature of Installer Date �1fcW 1 ' xMot.V1l1 1 Printed Name of Signee • `' MASON COUNTY PUBLIC HEALTH s .' The undersigned approves this Installation Report and . ' \ Record Drawing on behalf of Mason County Public cliuD w I ' Health; r LICP-N8ED DEPIGNER EXi+IRES e5e10/ Signature of Environmental Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Ilpda ed Wole Ar IVVI ►V v..�., , �Ako Ww/4t "ç liw-6 o.V% Ske vt iv. 4" o � wlrc tav► 5 - tir wt,1t, toot tvv►wi.�c, L�c �unk �� tubt n Ui S kAM4V 'Vnt, cAv ext≥ tt�i o, F�NR � Spay ill &clw�t,u1 Fur roc 6, ow,Vnk-S tNc►S O bi Wm aS vv g 1 raw c* `", =s %k puh(► (j (o16S o Ur. ?OS�►s a1 c�1n �k 1ocak►on I q0 ar _ Zo Q lye �tptyl.S 5?f APPROVED / ✓ MAY 14 2026 MASON COUNTY ENVIRONMENTAL NEAUT RE`� ,n�► ulw fah o w�away accts �/` `/✓ roq ,enc� �•/ Polio 6477.:6 Gra gpevlew Loop Rd,AIhIn,11 A 98524,USA, Union-Grapeview Township, Parcel 1d 122321001130 1 #RESIDENCE I I i 3 PUMP VAULT — � WNCH MARS TIjI1ii _5 CLEANOUT —f---! _ �► .. �cIft O�� P k i 1 _i b ��• 7 t BTRANSPORT LINE p �� i 3► 120800 0 500 �4 , S I1ZOO GALLONPUMP TANK ?D � � �• 1 _ _f PRIMARY DIiA1NFIELD—_ __ -- • _ 0 ;RESERVE DRAINFIELD ; rc, O 4 11 ' --- ,. !: Soy i %moo' SO N. o UTH NEIGHBORS WELL 1_-_ ts � 12 iNORTH - -- NEIGHBORS WE!! '� ii:'•' _" -', _ .. � — Z 2a 14 ;WATER LINE - —- . s--vim _ _ r.L ------------------------- •--------- r---r.--- __ -- - I __ ' r • / • `eelj ,4 GIs hd � it- io r I ° { WA Mason 10$:Contours O`&I&OAS .� ' ,ti aa### .`.6 / • .ssm- -- -,, __ -_ . --------._--------------- --- __ tea_ _� �y�-F[3,Bi'GYsY'1`_^.W'S.,�'art�z.uwtW r r•:- TO w�d5lY¢tiiaas'ila[.Z'1.+`++-.4#^+t.ay_ya`s-bWmt� PJ.�.r.e �J Cidlovyv�•� v3Ta y '+um'cK.+gna4[.w .rw.H�o..-..�. - of r _T 1.4 a� - - r . �w a _ firs a:� Parcel Lines gaffe :S i f — •--�, 11 V 1 I �, t�-' � �s (�� rte,, "-• � -+ •'i,.. _u..,.. cal -> i in : So f ' - �;� _ 5 e 1+Yy