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HomeMy WebLinkAboutSWG2023-00390 - SWG As-Built - 6/29/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG , ' _ C� Parcel # 221 - -H , -'2 2 l 1 +t- -H f 'CX,2p Applicant Name 1}�C ' t1 C, Subdivision (Name/Div/Block/Lot; Applicant Address City, State, Zip i t,,,W Q962-V Installer Name Site Address b '- mkt) &i1 }( t)4Y Designer Name INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑Drainlield Only ❑Repair ❑Other System Typed Pretreatment Type__ vmm ❑NIA vs ❑ Na >50ft.fromwells? -- - - - ---- _ ® ❑ >50 ft.from surface water? - - ---_th . ® O Cleanout between building and tank? Q1-_ ❑ 2 O Tank baffles present? -- - -- -- -- -,- -- --- -- -- - --- -- -----1 ❑ ,❑ O a24"access risers over each compartm r -- ❑ Z O rW Effluent filter installed?- -- _ - - -- --�.- ❑ ❑ Septic tank capacity(working) Jj `T✓ gal Manufacturer D-box water level and speed levelers used? -- - - - - - - - - - - - - - ,..❑ NIA ❑YES ❑ No RO Manifold/D-box accessible from surface?- -- - - - - - - - - - --- ❑ Check valves installed? - -- - - - - - -- -- -- - - - -- -- - -- - - -- ❑ O $ Transport Line Size 2 Schedule/Class— c.f Bedrooms installed (check one) ❑ 2 O 3 4 O 5 O 6 ❑Como}ercial/C7ther >10 ft.from foundation?- - - - ------- ----- -- -- - - - ---- ❑ N/A YEs ❑ NO >100A.fromwells?- - - - - -------------- -- ---- ---- ❑ ❑ W >100 ft.from surface water?---------- --- - - -- ---- -- - ❑ ❑ t% >10 ft.from potable water lines?-- - --- ---- - --- ------- - - ❑ O >5 ft.from property lines and easements?- --- - - - ---------- O ❑ >30 ft.from downgradient curtain/foundation drains? - - - -- - -- -- E1 ❑ C Drainfield level and observation ports present - ----- ----- - - - O ❑ O Graveless chambers or, Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - -- - - - --- - - --- O O Pump tank setbacks consistent with septic tank?--- - - - - -- -- -- O NIA ,. + YES ❑ NO XPump tank capacity(flood) gal Manufacturer_k'..-t,.. Q 24" access riser(s)and accessible from surface?- -- - - -- -- ---- 0 Alarm or Control Panel Installed? - - -- - - - -- --- - - - - ---- - ❑ ❑ Control Panel equipped with Timer t ETM!Counter - - - - - - - - -- ❑ ❑ Pump installed in [ Bucket or ❑ On Block or ❑ Oilier _ Pump Make/Model T Floats or ❑ Transducer '"t`t' ❑ e ---_ Tank draw down 2.Z''* intmin Pump t.tapacity _ gpm Squirt Height- 82f1 Pump on time " Pump off time Daily flow set at t.tp58teti 4r2VMxit& Mason County OSS Installation Report pg. 2 Parcel ABANDONMENT RECORD Were existing septic components abandoned as part of this p ct7 - - - -- d - -- - - - - -- YES NO It yes, please describe: Were all components pumped out and property abandon per O246-272A-Q3tltJ' -- _ - _ --- '/ES Nt7 RECORD DRAWING Thle to a pertnsttbM record and aruat be.C4orede end doacriptJve enough to ra-kys;atc in tits need of metr5ensncx eG4i itlu and N4ure dcY0topmant Typtcai F 9tx:ni i srRttrls Ccv earn bra vrraki S nanAotd a iesrpakwn S 16puj Sep hcip Jr n+tEtnk iucaiew'.Henri arrow,raaervn dw,,e d ex,stng amid aropoaed iocabwfi of wello wetM nos wnArs.obse na�k n Pom;ckaneut6.and othar mamie"ance acc»an p•,xbr+tr. t ornplele Re o.i[}rarfkt{}s may r,wo addaionat detayc in?root mtalation awrovsl and raieted pemri}�. 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 clearedlapproved by both the designer shown here have been clearedlapproved 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 l further certify that all information contained on this I further certify that all information contained on this d attached cord D awin is accurate form and attached Record Drawing is accurate. Si natur (Installer ata Dr ( /( i1 Pnnted fne of Stone MASON COUNTY PUBLIC HEALTI4 The undersigned approves this installation Report and Record Drawing on behalf of Mason County Public ALEX io 15�SE 12; fJ bM1 Ai - f Health: Signature of Environmental Health Specialist De to (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upd , MJP1% SHARED WELL 110' WETLAND /'\ / BUFFER / ,'� O= CLEANOUT / WATERLINE = CONTROL PANEL 15' B.S.B.L. / % © VALVE BOX / @= OB PORTS & CLEANOUT(X5) / /, f 4\ ORIGINAL / // C• ~ w W 14 PRIMARY fb W W W f W W W W I W W w W d` i I WWWWWwWW A } INSTALLED I i 4 © � w W W W W ; TANKS I i C / o�J f W w W W W w i I < /SOP / / W W W W W W{ I \Ii `C W WETLANDS w I I \s' / /W W W W W W W { ar W W w W W w 1 11 1 1 W W W W W W W/ \ 2 W w W W w W Wes/ \ ORIGINAL IW W W W W w W W W W Wr' RESERVE W W W W W W W - INSTALLED PRIMARY �\ W W w w W W (5-LATS @ 55',5'O.C.) \ \\ W W W { \ W W W ( \ W W W \ W w W W W ( W w " I \\ W W W I \\ I \ w W " 100% RESERVE W w W (ATU MAY BE REQUIRED) \ \\\ W W '4'I N `\ N \� w W W CHANGE IN DESIGNER: W W W DESIGNER INSPECTION \ I w W �� W W '4' W '4' � PERFORMED AFTER BACKFILL. � ` ` f�' W W W , CONTRACTOR PROVIDED \ A W W' PICTURES OF GRAVEL & FABRIC. 1.5"WASHED ROCK USED. �+ W /� W \\ �Py W \ J C2' 5110393 y W W W "N APPROVE ALEX L.PAYL 3E F� w W W W W `. LICENSED DESIGNER \ W W W W W W 5(PIIgS .v W .V W w W W w W W \�\ W W W W W T��T1 JUN 292026 IREC®RD DRY V 11i VG W W W w W W w\ MAS0N COUNTY ENVIRONMENTAL HE�LTh 4' w w W W 4' W W W CUSTOMER:JEFFREY&KATHY OWEN SEE DESIGN FOR TEST HOLE IN RMATION /N\ ( HI PARCEL: 22114 - 41 - 90020 II ALPINE SEPTIC SITE: 350 WILD GRAPE WAY -DESIGN- ALEX L PAYSSE,DESIGNER SHEET:ASUILT SCALE: 1"=50' DISCLAIMER: THIS IS NOT A SURVEY. REFERENCES INCLUDE APPLICANT/COUNTY PROVIDED PLATS OR 3089 E MASON BENSON RD II I SURVEYS,FIELD MEASUREMENTS AND COUNTY GIS. DESIGN INTENDED FOR SEPTIC PURPOSES ONLY. GRAPEVIEW WA 98546 II I I PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER DEPARTMENT/AGENCY REVIEW. DESIGNER NOT 360-507-1546 0 0.5 I 2 RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS.