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HomeMy WebLinkAboutSWG2025-00288-ASBUILT - SWG As-Built - 7/24/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00a-gY Parcel # 222067590231 Applicant Name CHRYSALIS REAL ESTATE SOLUTION LLC Subdivision (Name/Div/Block/Lot) Applicant Address 21530 NE 29TH ST TR 23-A OF SURVEY 1/137 TR B OF SP#445 S 56/60 City, State, Zip SAMMAMISH WA 98074 Installer Name Jon Johnson Site Address 1301 lahuya River DR, Belt air Designer Name Jim Zimny INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Gravity Pretreatment Type >5 ft. from foundation? - - - - - - - - - - ❑ N/A ® YES ❑ NO >50ft. fromwells? - - - - - - - - - - - - Z >50 ft. from surface water? - - - - - - - p - - - - - - ❑ ® ❑ H Cleanout between building and tank? - - _ L _�_� ZQ2�--L1 ❑ 0 ❑ U Tank baffles present? - - - - - - - - - - -- ❑ I LIE a24"access risers over each compartme __ _ -- __ - ❑ ® ❑ W I Effluent filter installed?- - - -- - - --- --- - --- - - -- --- ❑ ® ❑ 2. 1 Septic tank capacity (working) 1-80 Gallon gal Manufacturer Hageerman 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A l) YES ❑ No DO Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - ❑ ® ❑ OD z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ OQ Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ® YES ❑ NO >100ft. fromwells?- - - - - - - - - - - - - - - - - - -- -- - - - - - - - ❑ ❑ >100ft. fromsurfacewater? -- - - - - - - - -- -- - - - - - - - -- - - ❑ © ❑ ti >10ft. frompotablewaterlines?- - - - - - - - - - - -- - - - - - - - - - ❑ ® ❑ Z > 5ft. frompropertylinesandeasements?- - -- - - -- - - -- - - - - ❑ El ❑ Q X > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ © ❑ Drainfield level and observation ports present - - - - - - - - - - - - - ❑ ® ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - - ❑ El ❑ Pump tank setbacks consistent with septic tank? - - -- - - - - - -- - - M N/A ❑ YES ❑ NO Pump tank capacity (flood) gal Manufacturer Hageerman 24" access riser(s) and accessible from surface?- - -- - - - - - - - - - ❑ ❑ Alarm or Control Panel Installed? - - - - - - - -- - -- - - - - - - - - - ❑ ❑ Control Panel equipped with Timer! ETM/Counter - - - - - - - - - - ❑ ❑ d Pump installed in ❑ Bucket or On Block or ❑ Other Pump Make/Model Liberty 280 Moats or ❑ Transducer Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 812112018 Mason County OSS Installation Report pg. 2 Parcel# Z ABANDONMENT RECORD Were existing septic components abandoned as part of this projects - - ❑ YES NO If yes. please describe- Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - - - O YES ❑ NO RECORD DRAWING This is a permanent record and must be occurs%and dasctiptne enough to rs4ocsts to the need of maintsnanee acdvitfes and future developtn.M Typn, RJ L'raw rya centa Diamite a&manta d orrrdaaon 6 IaY,Ap.Sep.K rx.n+r.tar.*)m aton North anew re u'r draniee'd eA,sh,vj arv}pmposert GMdrx9s -ocatun a weft wasen,,,c Deus id,vvatn.n Cons cea.,ouls.ann a'rwr rime r,,rr:mp!e?e Record Urae nys ra,cre r'3 1 ' 5 nr4ay r.I.,.al,n!allal.on ap�roral and neate, [r,Yrn,l5 ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINE'ER 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 informatiorzcontained on this I further certify that all information contained on this form and attac d Record Drawing is accurate form and attached Record Drawing is accurate. ls-- I — l0 lure of telle� Printed Name of Signee ' MASON COUNTY PUBLIC HEAL , ✓(4 , The undersigned approves this lnstalla di� oft an� � � 7 N� Record Dra ing on behalf of Mason County ljc!tt¢�kl 6 LICE SEDDES,In, Health: (� /T R0Nfyl H Sign r re of Envir rental Health Specialist Date Islamp signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE t'°°a'"i`-,'"" ASBUILT 'i ' ` I / / Proposed WN ' V , ,. : 80' ,; 6" sleeved sch 4 ° 100' WELL RADIUS � �Qh I �� Reserve ------- �a e1205' Date: _ — Notasurvey __ 16/1/2026 tEND Design amp Designer Info: Applicant Info: — Datum NAD83 CHRYSALIS REAL ESTATE SOLUTION LLC Page Ji,r►z;mrly Bench Mark APD 1301 Tayhuya River Dr, soil log 7178 Windflower PL NW Beifair wa 98524 w well Seabeck, WA 98380 Scale — Property� 12 �. 222067590231 p ty Line LICE SIGNER - -• Power Line 1" = 40' APDdesigns(a icloud.com ---- Water line Ka /� ryiilam eflt: D 5No i fo: M "I Pt V •nc,rI' )ly�l}InnrI no (ountywn.go nndnvy Subject: 111virollnlMn io Inlhgalth r, lm, I'M OSS InspeCtion request for Chrysalis real estate solution - Swg2025-00288 Submittal request for: Chrysalis real es Site fate solution Address: 1301 NE Tahtrya river rd Permit Number: Sw82025 00288 Parcel Number. 222067590231 Installer Name:Jon Johnson 1 l Installer Phone Number: 3603401679 MAY 1 �?D26 Installer Email Address:jwjohnsonl9 By @gmail.com Designer Name: Jim Zimney Designer Email Address: apddesigns@icloud.com Inspection Request Date: 2026-05-18 Inspection Type: Full System Comment\ Notes: Thank you for submitting yo ur final install request.The install should be complete and ready to inspect on the'Inspecti Request on Date' and remain uncovered for three business days p to allow staff time inspect.p Poor g weather situations may Contacting onsite staff. Installer is responsible for obtaining Septic Desi ner Engineer installation be accommodated by components. If no contact is made by the health department within the three to backfill of system County Asbuilt Form, Record Drawing,and Installation fee must prior cover.Mason g, approval p the installer may business days o f notice, roval. be submitted for final installation app 1 1 Yom. Ik' A) j . It4{ F �Ts • • . iui ii • [% Tt- �[ r is t r� ,