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Home My WebLink AboutSWG2024-00269 - SWG As-Built - 7/16/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-ØO269 Parcel# 22132250070 Applicant Name Andrew Anderson Subdivision (NI me/Div/Block/Lot) Applicant Address 7223 HIGHLANDS DR NE PCL 7 OF LLS#23-01 City, State, Zip OLYMPIA WA 98516 Installer Nam Jake Goldy Site Address (0!E pndonia way, Grapeview Designer Name Jim Zimny INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type ( rtC -S4-c Pretreatment Type >5ft.fromfoundation? -- --- ---- --- �} / ---- - ❑N/A YES ❑ NO >50 ft. fromwells? ----- - -- -- Z >50ft.fromsurfacewater? - ---- - - - -:==;t?� ❑ HCleanout between building and ❑ ❑ U Tank baffles present? - - -- --- - - - - - --- - - - ❑ 0 ❑ a24"access risers over each compartmen . - - - ------ ❑ ® El LUEffluentfllterinstalled?------------------- - --- ❑ ® El Septic tank capacity(working) 1250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? ---------------� ❑ N/A 0 YES ❑ NO 9O Manifold/D-box accessible from surface?--- ----- - --------� ❑ ® ❑ QQCheck valves installed? -- - - - --------------- - ---- -, ❑ ❑ Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑3 E4 ❑ 5 ❑61 ❑Commercial/Other >10ft.fromfoundation?-- --- -- ----- ---- --- - --- ---- ❑ N/A NYES ❑ NO >100ft.fromwells?-- ---------------------------; ❑ ❑� ❑ LU W >100ft.fromsurfacewater? ----------------------- -' ❑ ® ❑ li >10ft. frompotablewaterlines?----- --- ------- ------ - El ® El >5 ft. from property lines and easements?-- ---- ---- -- ----, ❑ ® ❑ >30 ft.from downgradient curtain/foundation drains?---- -- --- ❑ ❑ Drainfield level and observation ports present - ------------- ❑ El ® Graveless chambers or ❑ Clean gravel used? (check one) � Proper cover installed over drainfield?-- ---- --- - --------- ❑ ® El Pump tank setbacks consistent with septic tank?-------------- ® N/A ❑ YES ❑ NO Pump tank capacity(flood) gal Manufacturer H24" access riser(s)and accessible from surface?-- ------ ---- - ❑ ❑ ❑ IL Alarm or Control Panel Installed? ------- ------ ---- ---- ❑ ❑ ❑ Control Panel equipped with Timer/ETM/Counter - --- - --- -- ❑ ❑ ❑ C- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other n' 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 6/21/2018 Mason County OSS Installation Report pg.2 Parcel#_2212 3 Scc 7o Were existing septic components abandoned as part of this project? --------------- ❑ YES J NO If yes,please describe: Were all components pumped out and properly abandoned per WAC246-272A-03007-------- [I YES O NO RECORD DRAWING pp This Is a permanent record and must be accurate and descriptive enough to ro.locele In the need of maintenance activities and future development Typical Record Drawings contain:Drolnfeld&manifold orientation&layout,Septk:fpump tank location,North arrow,reserve dreinfietd,existing end proposed buildings.location of wets,waterlines. welts.observation ports,cleanouts,end other maintenance mess points.tncornptete Record Dmwtnps may Cane additional delays In final Inslaltnton approval and related pemJts. .[Record Drawing Attached CERTIFICATION OF INSTALLATION:;; INSTALLER DESIGNER/ENGINEER i certify that t 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 form and attached Record Drawing is accurate. C form and attached Record Drawing is accurate. kQAM - 7-6 ' G Signature of Installer Date J gk Go s�R Punted Name of Signee ?5 F n 4 MASON COUNTY PUBLIC HEALTH y\•��', Nj The undersigned approves this Installation Report and 3 Record Drawing on behalf of Mason County Public trcL=N E p s1G�E Heal Signature of Environment I Health Specialis Date (stam ,sinature and date) p g THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated ttrzote Scanned with CamScanner Designer Info: 613' ASBUIILT el 166' el 16 ' Jim Zimny APD 7178 Windflower PL NW Seabeck,WA 98380 APDdesigns@icloud.com 50'attenutation zo 'k� w ohm 171' t w bn nm y DESIGNER ID 0 TH#3 C 2 196' �' reserve z r rn 70' TI4 i oo o a rfl rn �q p p u �i O;i BEDROOM_H ---------------------- ------------- h20 & Power z 171 el 18 ' 613' 50' el 198' N Applicant Info: Andrew Aderson Date: Scale 1" _ 61 E ADONI WAY #221232250070