Loading...
HomeMy WebLinkAboutSWG2025-00056 ASBUILT - SWG As-Built - 6/15/2026 • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00056 Parcel # 221232250030 Applicant Name Shaman Burton Subdivision (Name/Div/Block/Lot) Applicant Address 41 E HEAVENLY LANE City, State, Zip UNION WA 98592 Installer Name Jon Johnson Site Address 50 EADONAI WAYGRAPEVIEW.WA 98546 Designer Name Jim Zimny INSTALLATION CHECKLIST Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type gravity Trenhes Pretreatment Type >5 ft. from foundation? - - - -- ---- --- - - - ❑ N/A ® YES ❑ No >50ft. fromwells? - - - - - - -- -- r _ _ ❑ ❑ >50 ft. from surface water? - - - - - ❑ ® ❑ Z H Cleanout between building and tanks - �- � _ _ _ ❑ © ❑ U Tank baffles present? - - - - - - - - - -- ------ - - - --- _ ❑ ❑ d24"access risers over each compart ?---- --_ - ❑ © ❑ UJ Effluent filter installed?- - - - - - -- ❑ © ❑ rn Septic tank capacity (working) 1250 gal Manufacturer Haagerman " O D-box water level and speed levelers used? -- - - - - - -- - - - - - _ ❑ N/A YES ❑ NO ><O Manifold/D-box accessible from surface?- - - -- - - - - - -- --- - - ❑ I] ❑ LL mz Check valves installed? - - - - - - - -- - - - - - -- - - - 0 ❑ ❑ Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑3 EI 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - _ ❑ N/A a YES LINO >100ft. fromwells?- - - - - - -- - - - - - - - - - -- - - - - - - - - - - ❑ © ❑ W >100ft. fromsurfacewater? -- - - - - - --- --- - - - - - - - -- - - ❑ ❑ ME >10ft. frompotablewaterlines?- -- - - - - - - ---- - - - - -- -- - ❑ El ❑ z > 5 ft. from property lines and easements?- - - - - - -- - - -- - - - ❑ II ❑ > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ © ❑ Drainfield level and observation ports present - - - - - - - - - - - -- - ❑ Ii ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - -- - - - - - - - - - - - - - - - ❑ ® ❑ Pump tank setbacks consistent with septic tank?- - - - - - - - - - -- - N/A ❑ YES ❑ NO Pump tank capacity (flood) gal Manufacturer Z < 24" access riser(s) and accessible from surface?- - -- - - -- - - - - - ❑ ❑ ❑ a Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑ Control Panel equipped with Timer!ETM/Counter - - - - -- - - - - - ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a 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 6/21/2019 Mason County OSS Installation Report pg. 2 Parcel 9 22 Z 2 2-S uo o ABANDONMENT RECORD Were existing septic components abandoned as pan ;f tnlg protects ❑ YES NO if yes please describe Were all components pumped out and properly abandoned per WAC24ti-272A-03007 - - -- - - - ❑ YES ❑ NO RECORD DRAWING This is a permenont Iseord and must be aceurats and daecn fl vs enoryh to raloeats in ttis raed of mainterrancs ativitiss and future develupment Type.al Rrx,-J L'raw rgs coin ' Draxdre a 8 manf 'd orm 4mrn S layi' S:y'-.jn lack lrti..tar+ Nth asr *n..' o'J n,e n i n7 ni'G". n teelio):. oalon' we'ra War ,( :.g'Js dxevatnw+bons c ea,+ouls x+„oic*c maeaenen:.e a&:bs pr+Ms rwnny'..'.f+eccrd Drae nit cu+cleat'!a-1hL(.c'al delays e,f.,al rrnslallaf,on approval and a ate,,pn n,I<. 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 showi here have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet ail and Mason County Codes. State and Mason County Codes i further certify that all informatiou-contained on this I further certify that ail information contained on this form and attac d Record Drawing is accurate form and attached Record Drawing is accurate. lure of taller Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH 1 F s r � The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public 01 Fj Health: uc ,,FD,..ES!GNER Sicnnture ofFnvironnienial ealth Specialist Date stamp signature and date) H S FORM\IA., BE SC,;NNED.,ND AVAILABLE FOR'JBLIC t tEW ON THE MASON COUNTY WEB S;T E ° °" 657' el 202' I i N AS BUILT I _ W E APPROVED s JUN 15 2026 MASON COUNTY ENVIRONMENTAL HEALTH 2T 313' 270' t3 OO e1202 bedroom home I I P � I Im D/W W I ; I ' � I 100' w 11 radius �' �`• Date: ' \ 5/5/20 5 Bench Mark Datum NAD83 Desigr er Stamp Designer Inf : \ Applicant Info: Soil Log Not A survey Page el 98' Jim Zimm APD Property Line 7178 Windllower P NV Burton/Nolan - Line Scale wel I L Seabccls"\9838(1 54 E Adoni Way. •_. —_ - --- f APDdcsignsOicloicon Grapewiew WA Water line > "_= Sur; d 221232250030 Rhonda Thompson From: DO NOT REPLY <noreply@masoncountywa.gov> Sent: Sunday, May 17, 2026 6:39 PM To: Environmentalhealth Subject: OSS Inspection request for Amber Nolan - Swg2025-00056 Submittal request for: Amber Nolan Site Address: 50 E Adonia way Permit Number: Swg2025-00056 Parcel Number: 221232250030 Installer Name:Jon Johnson Installer Phone Number: 3603401679 Installer Email Address:jwjohnsonl9@gmail.com Designer Name:Jim Zimney Designer Email Address: apddesigns@icloud.com Inspection Request Date: 2026-05-17 Inspection Type: Full System Comment\ Notes: Thank you for submitting your final install request.The install should be complete and ready to inspect on the 'Inspection Request Date' and remain uncovered for three business days to allow staff time to inspect. Poor weather situations may be accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backfill of system components. If no contact is made by the health department within the three business days of notice,the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 1 MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2025-00056 ADDRESS: 50 e Adonai Way PARCEL: 221232250030 DATE: 5/18/2026 I ,y HOUSE TO DRAINFIELD DRAINFIELD TO HOUSE