HomeMy WebLinkAboutSWG2025-00214-ASBUILT - SWG As-Built - 8/10/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWGZOL 5- DC)a l Parcel # 220 Lt 76 -000`/U
Applicant Named Subdivision (NamelDiv/Block/Lot)
Applicant Address �o 8X 1964
City, State, Zip Ss uba, VJA 9f^i5eL1 Installer Name .Y�iZ ,O,_n
Site Address 424 5 F' A U U*A 1 - Designer Name W'&cL( U..J'A'
INSTALLATION CHECKLIST
Full System Installation ❑Tank Ls)Only ❑ Drainfleld Only ❑Repair ❑Other
System Type uiDi2 I42Zj4tt 112srr-t1 Pretreatment Type
>5 ft. from foundation? - -- - - --- -- - --- ---------- --- 0 W iYES O N
>50 ft. from wells? - - - - - - - - - - -�^ ---f�__-_- - --- - ❑ ❑
i >50 N. from surface water? . -- ---i17Bir;µr� �{/p - ❑ ❑
H Cleanout between building and tank?; gf,!ni 1.----N=-' -1 u - ❑ ❑
V Tankbafflespresent? - - -- - - - -JJi'- -IUl-at ❑ ❑
24 access risers over each compart{rent?--- ---- ---- -- ❑ ❑
W Effluent filter installed?---- - -- - y=_--- - --- -- - - 0 ❑
N -
Septic tank capacity(working) IZOO g rer S
O D-box water level and speed levelers used? -- - --- - ------- - EN/A ❑YES O N
00 Manifold/D-box accessible from surface?-- --- - - - -- ------ - ❑ ❑
mz Check valves installed? --- - - - - -- - --- --- - - - - -- --- - ❑ ❑
cc It
f Transport Line Size Z r.C. Schedule/Class r--1
Bedrooms installed(check one) ❑ 2 3 lJ 1 ❑5 ❑6 ❑Commercial/Other
>10f. from foundation?- -- - - ---- - - - - - - - --- --- - - - - ❑ WA 9YES NO
O >10o ft.from wells?.---- - -- - - - --- ----- - - --- --- -- ❑ ❑
-� >l00 ft. From surface water? - - --- - - - - - - ---------- -- ❑ ❑
W
LL >10 ft from potable waterlines?- - - - - - - - - - - - - - - - - - -- -- ❑ ❑
> 5f. from property lines and easements?- -- --- - - -- --- - - - ❑ ❑
> 30 ft. from downgradient curtain/foundation drains?---- --- - - - O ❑
Dralnfield level and observation ports present - - -- - - - - - - -- - - O ❑
❑ Graveless chambers or X Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - - ❑ ❑
Pump tank setbacks consistent with septic tank?--- - - - - - - - --- ❑ WA YES ❑ NO
Y Pump tank capacity(flood) gal Manufacturer -Sus
Q24"access riser(s)and accessible from surface?- - - -- - ---- - -- O ❑
Alarm or Control Panel Installed? ❑ ❑
Control Panel equipped with Timer/ETM /Counter- - - - - - - - - - - ❑ $f ❑
a Pump installed in ❑ Bucket or X On Block or ❑ Other
Pump Make/ModeY�L£tL:-YZ '4 r5 — Floats or ❑ Transducer
3 Tank draw down in/min Pump Height
n capacity Squirt Hei ft
Pump on time • 6 A—V Pump off time Daily flow set at 273 gpd
awa.H xvmtn
i,Iason County OSS Installation Report pg. 2 Parcel* 27O29 -7 6- Oco 90
ABANDONMENT RECORD
"Ware exifing septic co:rnperents soanoonec as cart of :ri= project - -- - - - - ---- - - -- Gl YES NO
ye
s. ;lease de5cr5se.
,Vete ai components pumped cut ant property acandoned per lAAC248-272A-CSC:? - - -- - - -- ❑ YES /-i ❑ NO
RECORD DRAWING
fl his 1c a permanent/ncom and..at be arsurrs ana excnptva maven to re-boat. n the need of mirt nand activities and town dwebpmmt TyF:ui Rerom
J'axngs Ofl1,rt a a ..n-.w - , xp +-.. arc-c10, ' rtn atrw.r. .e rr*; .Aet'r;art DtOSQ Xddkge. aatpn al we.a,x'd roes.
'.ads,mIerar: m-4. ar-- er. -.cve.<c _ess a . , me ae o,d Jaen'::ga me aye waisca'ca in inenneullation apwvel.:rd rallied permlR.
rn flit' teendeMar p,✓ rfe
(2 t 0/v"r�I" 1 .f moue) .4
/VO yn ea l� Cog -.o, 0,6
�CQJeUcip
Lerld
1 / V
G�aPer-
ra-eC
Record Drawing Attached
CERTIFICATION OF INSTALLATION - -
i INSTALLER I DES 3NER!ENG:t.EER
I certify that!Installed the system in accordanea wnh ; ;con: 't^a!the system has been installed in accor-
I the septic design stamped-APPROVED"hr,Masoi ? On wt,' Ire septic design stamped'APPROVED"by
County Public Health and;het ant/deviations show.•• Masoi CG;r.ry-u3uc Heath and that any deviations
here have been cleared/epprovec oy bash rte des .-sr i tf0.:n here hbva ^ea^ cieared/approved by both—
and Mason County P-biic.Health and moe.r r 5:e.o j ryse. ana Mason Ccunty Public Health and meet all
i and Mason Counti Codes. Site &ad arsscn County Codes
I further certiy that at!%ntr-at✓r costa,ac Cr rh. . .uvher cerWv that all Information contained on this
form and attached re,-::c .534 J:13:C. _ tic and atrEcbed Record Drawing is accurate.
"Kra a,n'fcrct( o- .,(t
Printed Name of Signee ty_ „ fr
MASON COUNT';?-'SLC -.EAii re. it '*•�
The undersigned appm.,as th;I; stal!afcn»port a wu ¢.. Cl yy -t q ., b
Record Dram; _ era'i O a. rq Cocr; °abn:: - LILErJ'$ pp
Heal(
Signature or Erri"t nt Has= Suecians± Date ;s,amp. s%gnaiure and date)
IS 9 S'.iA 3E S ..knE]a ?h;_„----'C rt 'E7 E \ $:.N CO j'\IV WEB SITE -pmtc<.a'a h
I I I I .._�;-t
TITT
TiTiTI :LHH4 tT1'' h-I-
I -I
r - _ ' � }-
L
11 t
a I
-. I '
rte- Li
- - - - - --
rt 4--- --
1
_
11
_� E {- �- �- _y-4_.f._ -r - ter
{
gyyd R1Joo'J nosey,way Paiwd
SINc Fjuno uose wad pe1ui d
hac _,
..� p v y z p
t+ -1 >p D xy O z> O S
pp
it
x M3NDIS3 3SN3 11 ' .V
q 31ivm 3� QNID �Q I
II !
N O
O u - tbAWN .
�a u
1 o � pm a
OAl
,/r, .� Sa2omm � o ≤ 1ypE.
S.
a =, act xp
m
C CD
0 o o
m 9
APPRQ\
AUG I orz,
s �{S
! MAS0NCCU4TYEWInd1
DRAINFIELD LAYOUT
vq. __ - -
19.
14g.
it1. ' '• T -. __ __
,II
-R
XI-CLEANOUTIOBS PORTS 4)
X2=D BOXIVALVE BOX I )L
X3-CMokVelva/y) r vo/w W.4 APPROVED
al Lopa Control elves(y S u v o/rr
X S G�� AUG 05 ti4A$0.4000hTrE5v� n
SL /t P,ET WAL NE4M
. g " lflisciAvt
Printed From Mason County DMS
Prints fmm Mason County®MS
MASON COUNTY
Public Health & Human Services
FINAL INSPECTION:
SWG2025-00214
ADDRESS: 421 SE Kalium Dr
PARCEL: 220297600040
DATE: 7/13/2026
G ® Y P
r.
HOUSE TO DRAINFIELD
r a% ;r . \ m .yr
DRAINFIELD TO HOUSE
rla Milam
m: DO NOT REPLY <noreply@masoncountywa.gov>
t: Monday, July 13, 2026 7:54 AM
Environmentalhealth
jec : OSS Inspection request for Brandon Devaney - 2025-002014
)mittal request for: Brandon Devaney
Address:,1 SE Kalium Dr.
rmit Number: 2025-002014 D
rcel Number: 22029-76-00040 D JUL 132026
II
staller Name: Bamford Septic
By
staller Phone Number: 3607902364
staller Email Address: bamfordseptic@yahoo.com
signer Name: cindy Waite
esigner Email Address: cindyewaite@msn.com
spection Request Date: 2026-07-13
ispection Type: Full System
omment\ Notes:
hank you for submitting your final install request.The install should be complete and ready to inspect on the 'Ins
equest Date' and remain uncovered for three business days to allow staff time to inspect. Poor weather situations
,e accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installa
pproval prior to backfill of system components. If no contact is made by the health department within the three ;.
iusiness days of notice, the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation fee m
>e submitted for final installation approval.
5