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Home My WebLink AboutSWG2023-00260-ASBUILT - SWG As-Built - 6/15/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00260 Parcel# 222137700060 Applicant Name James Sanding Subdivision (Name/Div/Block/Lot) Applicant Address 7002 35TH ST W City, State, Zip UNIVERSITY PLACE WA 98466 Installer Name Korbyn Hurley Site Address 220 E Johnson Ridge Designer Name Jim Zmny INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type Pressure Distribution Pretreatment Type >5 ft. from foundation? -- --- ---- �� ❑N/A ®YES ❑ NO >50ft.fromwells? - ----- ---- -- — Z >50 ft.from surface water? ------- Ii -JU —1-5 &- El ❑ ® ❑ Cleanout between building and tank? -------- ------- -- ❑ 4 ❑ Tank baffles present? ------ --- - 8y-- -,- - ---- ❑ 0 ❑ 0~. 24"access risers over each compartme - ------ ❑ 0 ❑ W Effluent filter installed?--------------------------- ❑ 0 ❑ Septic tank capacity(working) 1250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? -- ------------- ® N/A ❑ YES ❑ NO 0O Manifold/D-box accessible from surface?----------------- ❑ ® ❑ mz Check valves installed? -- -- - ------ --- ------- ----- ❑ 0 ❑ oa M Transport Line Size 211 Schedule/Class Sch 40 Bedrooms installed (check one) ❑ 2 ■❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft.from foundation?----- -- ------------------- ❑ N/A OYES ❑ NO >100ft.fromwells?---- ----------- ---------- ---- ❑ ❑ W >100 ft. from surface water? ---------------- -------- ❑ 0 ❑ M >10ft.frompotablewaterlines?---------------------- ❑ 0 ❑ Z >5 ft. from property lines and easements?--------------- ❑ 0 ❑ 9 > 30 ft.from downgradient curtain/foundation drains?---------- ❑ 0 ❑ C3 Drainfield level and observation ports present ------- ------ ❑ 0 ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?----- -------------- ❑ 0 ❑ Pump tank setbacks consistent with septic tank?------------- ❑ N/A 0 YES ❑ NO Pump tank capacity (flood) l2.x gal Manufacturer Hagerman zQ 24"access riser(s)and accessible from surface?------------- El ® ❑ aAlarm or Control Panel Installed? --------------------- ❑ ® ❑ Control Panel equipped with Timer!ETM I Counter-- -------- - ❑ 0 ❑ Pump installed in ® Bucket or ❑ On Block or ❑ Other a Pump Make/Model Liberty L280 IM Floats or ❑ Transducer 0=. Tank draw down 1.5" in/min Pump capacity 30 gpm Squirt Height 5' ft Pump on time 2 min Pump off time 4 hrs Daily flow set at 360 gpd Updated 821!2016 Mason County OSS Installation Report pg. 2 Parcel# Z2 ZI -S- 77- £ 2( 'C ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ----------- ---- ❑ YES NO If Yes,Please describe: Were all components pumped out and property abandoned per WAC248-272A-0300? -------- ❑ YES NO RECORD DRAWING Thie is a permanent record and must b.accuratrt and dmrlptin enough to relocate In the need of maintenance eCtNt1Ns and Mitre devetopmant. Typical Record Otmatngs Contain Qramfield i mwtdd oriemaeon&layout.Septi<yp. p tank tocabon,Nom arrow.reserve drarnleld.resting and proposed buildings.location of weld.waterlines. wets.otuervatan port•cteanouts.end other matntenan a access points incomplete Record DrxMngs may create additional delays In final installation approval and related permh 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 cleareWapproved 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 /further certify that all information 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. eon ter Date Icon I4urky Printed N e of Signee r, ri MASON COUNTY PUBLIC HEALTH / a 1 Jerno X Zhrvry The undersigned approves this installation Report and LICENSED ESIGNER Record Drawing on behalf of Mason County Public (� Health: (s t 'Z*' Signature of Environmental ealth Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VVEB SITE U1XjMed e2112018 Designer Infp---- ------------------------------- Jim Zimny I N AS BUILT U I LT APD W 7178 Windflow PL NW Seabeck,WA 98 80 APDdesigns@icoud.com o��2 f I Applicant Inf : 220 EJohn3on Ridc a Dr Belfair wa #22213-7l-00060 Desig temp Re rve �Py F el 289' H#3 o J6 4A13N��' Hyd Splitte . LICEN ED SIGt ER ' I p` 3 bedroom ai Home I 756' Po`Ne, oV "N o I / -, ______________ Date: 5O 6/1/26 o Page I I Scale 1" = 40' ----------------------------------------------- Area of Detail