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HomeMy WebLinkAboutSWG2025-00385-ASBUILT - SWG Application / Design - 6/1/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00385 Parcel # 223097690151 Applicant Name Kathlene Swope Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 544 TR 15-B OF SURVEY 12/34 TR B OF SP# 1695 City, State, Zip BELFAIR WA 98528 Installer Name Jim Zimny Site Address 151 Bedrock Ln, Belt air WA 98528 Designer Name Join Johnson INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type ATu To Pressure Distribtiuoin Pretreatment Type Nuwater BNR 500 >5 ft. from foundation? - - - - - - - -- --- - - - - --- - - - - - - - - El N/A ® YES NO >50 ft. from wells? - - - -- - - - - - - r - _ - - - - - - ❑ © El Z >50 ft. from surfacewater? - -!� - ❑ ® ❑ Cleanout between building and tank? rit -- ---------L3ff / - El ❑� ❑ U Tank baffles present? - - - - - - - - -14 - -L 7 ❑ ❑ a24"access risers over each compact ent?-- - - - - - ----�_- - - ❑ ® ❑ Septic tank capacity (working) 1000 ga er Envioflo 0 D-box water level and speed levelers used? - - - - - - - -- - - - - - - ® N/A ❑ YES ❑ NO �O Manifold/D-box accessible from surface?- - - - - -- - - - -- -- - - - ❑ © ❑ mz Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ Transport Line Size 2" Schedule/Class sch 40 Bedrooms installed (check one) ❑ 2 ❑3 A 4 ❑ 5 ❑6 ❑Commercial/Other >10ft. fromfoundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A YES ❑ NO >100ft. fromwells?- - - - - -- - - - - - - - - - -- - - - - - - - - - - - ❑ 0 ❑ W >100ft. fromsurfacewater? - - - - - - - -- - - --- --- -- -- - - ❑ IN ❑ 1Z >10ft. frompotablewaterlines?- - - -- --- ---n-7-_-,1 ❑ ® El ? > 5 ft. from property lines and easemet ?- JUL_U_ .20� _- ❑ ® El > 30 ft. from downgradient curtain/fount itiQfRCiivl€WA1iEA: ` ❑ © ❑ O Drainfield level and observation ports present --jBW ❑ II ❑ • Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield? - - - - - - -- - - - - - - -- - - El U] ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ❑ N/A YES ❑ NO Pump tank capacity (flood) 1000 gal Manufacturer Hagerman Z < 24" access riser(s)and accessible from surface?- - --- -- - - - - - - ❑ Ii El Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ U ❑ Control Panel equipped with Timer!ETM/Counter - - - - - - - - - - ❑ U ❑ Pump installed in ❑ Bucket or ® On Block or ❑ Other Pump Make/Model Liberty 290 • Floats or ❑ Transducer Tank draw down 3" in/min Pump capacity 60 gpm Squirt Height 10' ft Pump on time 1 min Pump off time 3 firs Daily flow set at 480 gpd updated 8R1 1,C18 Mason County OSS Installation Report pg. 2 _____________________— ABANDONMENT RECORD ere existing septic components abandoned as pa'r ;! tn,s project ❑ YES �No if yes please describe :Nere all components pumped out and properly abandoned per WAC246-272A-03007 - - - - - - [] YES NO RECORD DRAWING T-ns Is a permanent record and mum be accurate and descriptive e,eou9n to re-.cata it,the need of maintenance acts'lxs and future devetopm.M Type;ai 1,: aw'rgs contaa, otarnfw-o 6 manta i,,tei,tafon S laytwt Siam.ta,u Iar.a!o, ton No tt.anew anUrkf ralsUny atH L+ofxne,.,tr,aldwy, ,u at "wr'l•, way: .., :nsn- r a,;,ryes r Hai arle arb othw maaNananc,acrrsa pains tnu,n,7tMe NecorC Orawnc nun create ataton►1 delays 1n Unal atslalbl,on approval arvl'e aIn. p P 0 " JUL 07 7 2026 MASON COUNTY ENVIRONMENTAL HEALTH JBW Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER: ENGINEER i certify that/installed the system rr.,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 Lv 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 attac d Record Drawing is accurate form and attached Record Drawing is accurate. [_( tore of taller LL Date ti U Pm',,'Fd Name of Slgnee MASON COUNTY PUBLIC HEALTH /y the undersigned approves this Installation Report and y 12 Record Drawing on behalf of Mason County PublicLICE E DESIGNER Health: S!yrr;Nrrrr v crnnurrrtat Health Spe 4r(is! O is (stamp Signature and date) i HAS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE i ASBUILT el 418' 451' e145 ' 25' 1 0 28 1 r Re ry TH 1 P per Pole 8%slope G jL/1 S EL p'. (N % • -• q C i 1-1000 Gallon Trash Trap 2-1000 Gallon BNR 500 3-1000 Pump Tank 4-hydrosplitter \ o i el 417' 449' el 5 ) I/is 151 LEGEND Datum NAD83 4 s ® Bench Mark / t soil log ENSEE DESIGN --Nell LICENSEDDESIGN£R — roperty Line __ Power Line — Water line Not A Survey a la Milam From: Sent: DO NOT REPLY <noreply@masoncountywa.gov> To: Tuesday, May 19, 2026 7:46 PM Subject: Environmentalhealth OSS inspection request for Kathline Swope - Swg2025-00385 Submittal request for: Kathline Swope Site Address: 151 NE Bedrock rd Permit Number: Swg2025-00385 Parcel Number: 223097690151 Installer Name:Jon Johnson !rr Installer Phone Number: 3603401679 By Z0?S Installer Email Address:jwjohnsonl9@gmail.com Designer Name:Jim Zimney Designer Email Address: apddesigns@icloud.com Inspection Request Date: 2026-05-19 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 'Inspec Request Date' and remain uncovered for three business days to allow staff time to inspect. Poor weather situations m; he accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installatior 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 Cdunty Asbuilt Form, Record Drawing, and installation fee must be submitted for final installation approval. JL 1 11 � � 1 1 • .h 9y#" I ; � I: m A •,�- t Tyr- _