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HomeMy WebLinkAboutSWG2025-00171-ASBUILT - SWG As-Built - 6/22/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00171 Parcel# 22104-43-50010 Applicant Name Michael &Tina Lawson Subdivision (Name/Div/Block/Lot) Applicant Address 511 S 196th St City, State, Zip Des Moines, WA 98148 Installer Name KRS Excavating, LLC Site Address 610 E Benson Ridge Rd, Grapeviev Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ©Other 500 gallon pre-trash tank System Type Shallow Pressure Trench Pretreatment Type NuWater BNR-500 >5ft. fromfoundation? -- -- -- - - - - - - - - - - - - - - - - - -- -- ❑ N/A AYES NO >50 ft.from wells? - - - - - - - - - - - -- B W � ❑ � ❑ >50 ft.from surface water? - - - - - - - - ❑ UI ❑ Z HCleanout between building and tank? - - - --------H-- ❑ © ❑ Tank baffles present? - - - -- - - - -- - -J 22� - Li ❑ II ❑ d24"access risers over each compartment - - - - - - - - - - - - ❑ Ii W Effluent filter installed?- - - - - - - - - - B/- - - - - - ❑ ❑ ■❑ N Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman C1 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A ❑ YES ❑Q NO �O Manifold/D-box accessible from surface? - - - - - -- - - - - - - - - - ❑ Q ❑ fT Check valves installed? - - - - - - - - - -- - - - - - - - - - - - - - - - ❑ III ❑ OQ E Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?- - -- - - - - -- - - - - - - - - - - - - - - - - ❑ N/A © YES ❑ NO >100ft. fromwells?-- - - -- - - - -- - - - - - - - - - - - - - - -- - - ❑ UI ❑ W >100ft. fromsurfacewater?- - - - - - - - - - - - - - - - - - - - - - - - ❑ UI ❑ u. >10ft.frompotablewaterlines?- - - - -- - - - - - - - - - -- - - - - - ❑ 0 ❑ Q > 5ft. frompropertylinesandeasements?-- - - - - - -- - - - - - - - ❑ ® ❑ LX > 30 ft. from downgradient curtain/foundation drains?- -- - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - - -- - - - - --- - - ❑ © ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- -- - - - - - -- - - - - - - - - - ❑ UI ❑ Pump tank setbacks consistent with septic tank?-- -- -- - - - -- -- ❑ N/A ® YES ❑ NO `-L Pump tank capacity(flood) 1,250 gal Manufacturer Hagerman . 24"access riser(s) and accessible from surface?- - - - - - - - - - - - - E ® D Alarm or Control Panel Installed? - - - - - - - -- - - - - - - - - - - - - ❑ © ❑ Control Panel equipped with Timer/ETM/Counter - - - - -- - - -- ❑ II ❑ - Pump installed in ❑ Bucket or ® On Block or ❑ Other O- Pump Make/Model Liberty 280 ® Floats or ❑ Transducer 2 Tank draw down 2.1 in/min Pump capacity 46 gpm Squirt Height 2 ft Pump on time 2.3 min Pump off time 6 hr Daily flow set at 420 gpd Updated 6252018 Mason County OSS Installation port pg. 2 Parcel# 221044350010 ABANDONMENT RECORD Were existing septic components abandone as part of this project? - - ---- - - ------- ❑ YES NO if yes, please describe: Were aft components pumped out and p=ope abandoned per WAC246-272A-0300? - ------- ❑ YES NO RECORD DRAWING This is a penm3nern record and must bu accuraU and d4 flc mwuyh to ra4oc*t is the neod d mainitnance ac1Mtts arod future developme ct. Typ1C Reco O(+9z co Dcvrf oid a n aid omen&bywtS 4p ta.dc North -.h ,n d+sv d.o ' and pogo.od of wa66. =. wells obse°rvban por6.deanaas.and other reainlenance ac piflS Ump3ete RacorC at-gs may ode addC and delays rn Ana!usCiNabon 8p4 lwaI 3TM rde ec PCML'ts. Record Drawing Attached CE TIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that I installed the system in ac rdance with I certify that the system has been installed in accor- the septic design stamped APPROVE r by Mason dance with the septic design stamped"APPROVED"by County Public Health and that any de✓ cins shown Mason County Public Health and that any deviations here have been clearedlapproved by b the designer shown here have been clearedlapproved by both and Mason County Public Health and n et 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 conta'ed on this I further certify that all information contained on this ;igZna2ur& ttac ecord Drawing is a urate. form and attached Record Drawing is accurate. ofJnstafer Date Donald Mir•.iken iii Printed Name of Signee ' :r os r •;�h MASON COUNTY PUBLIC t fEALTH The undersigned approves this Installal n Report and Record Drawing on behalf of Mason Co ty Public 1349 s c� PAULA JOY JOHNSON Health: J) J14 7I/ )72 Q: Signature of Environrn9A tal Health Speciet' f bate (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVALLABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updarcd d212ot8 a � .. TR��L`�ES � as D•G • fit'}` RS5 •°E '4• AS t L-T 3e c L rt Z2to4- 43 001D 1 1 \ �t • 5100349 •. ��� ( 1 .• PAU!A JOY JOHNSON' 'k i Q7 • 3 ,{ Q 9 ro:c 4 .9K s PPROV ! i E . 0 O'- Azco-Visup?nlw- { MASON COUNT Eh' 2016 O Cleanout • RE CNMEh'rq�hEALTH/ 9����� 500 Gea,lon Pre-Tram M:.,, f ? \. O NtCVaier BNR-500 RTU Tank / O 1250 C�Ilor.A:mn Chamber i i S � ur-4in axt:•s;yaoti / O6 Valve Contra,Sox 7 \\ \/ // paJb / ii Kayla Mlam From: DO NOT REPLY <noreply@masoncount Senr: Monday, May 4, 2026 4:25 PM ywa.gov� To: Environmentalhealth subject: OSS Inspection request for Don Miniken - swg2025-00171 Submittal request for: Don Minikes Site Address: 610 E benson ridge rd Permit Number: swg2025-00171 Parcel Number: 221044350010 Installer Name: Don Miniken Installer Phone Number: 253-250-9932 0y Installer Email Address: don@ksrexcavating.com Designer Name: Paula Johnson Designer Email Address: paulaj@hctc.com Inspection Request Date: 2026-05-05 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. �• . MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2025-00171 ADDRESS: 610 E Benson Ridge Rd PARCEL: 221044350010 DATE: 5/6/2026 HOUSE TO DRAINFIELD DRAINFIELD TO HOUSE