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Home My WebLink AboutSWG2026-00023 - SWG As-Built - 9/21/2026 Mason County OSS Installation Report pg. 7 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00023 Parcel# 319024100030 Applicant Name Hess. Daniel&Sara Subdivision (Name/Div/Block/Lot) Applicant Address 16623 Elderberry St SW City, State, Zip Rochester WA 98579 Installer Name Andrew Lehman Site Address 161 SE Wellswood Way Designer Name Jim Hunter INSTALLATION CHECKLIST UJ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type pressure distribution PretrealmeentType >5f1 from foundation? - - - - - - - -- t- ❑I.NIA •YES NO >50 ft.from wells? -- - - - - - - - - --- -- - -_c - - - - - -- - - S ❑ Y >50 ft.from surface water? - - - - - - - -r-.- {f-} 42L ❑'. ® ❑ Z F Cleanout between building and tank? - +�- ❑ U 0 U Tank baffes present? - - - - - - - - - - - - - -' - Q ❑ 1 24" access risers over each compartment?- - -- ----- -- ❑ ® ❑ a WEffluent filter installed?- - - - - - - - - - - - ---- - - - ❑ ■ ❑ Septic tank capacity (working) 1250 gal Manufacturer HB Precast O D-box water level and speed levelers used? - - - - - - - - - - -- - - - eN/A DYES O N J DOLL Manifold/D-box accessible from surface?-- - - - - - - - - -- -- - ❑ ❑ - - £?z Check valves installed? - - - - - - - - - - -- - - - - - - - - - - - - -- U 0 ❑ �Q2 Transport Line Sze 2 inch Schedule/Class sch 40 Bedrooms installed (check one) ❑ 2 ❑3 ❑� 4 ❑ 5 ❑6 ❑Commercial/Other ,10ft.from foundation?- - - - - - - - - - - - - - - -- -- - - - - - -- ❑ NIA ■ VES ONO >100 ft.from wells?-- -- - - - - - - - - --- --- - - - - - - - - -- ❑ ® ❑ W >100ft.fromsurfacewater? - - - - ---- - -- - - - - - - - - - ---- ❑ ® 0 LL >10ft.from potable water lines?- - - - - - - ----- - - - - - - - - -- ❑ ❑ Z > 5ft.from property lines and easements?- - - - - - - - - - - - -- - ❑ ❑ 9 > 30 ft.from downgradient curtain/foundation drains? - - - - - - - - -- ❑ e ❑ G Drainfield level and observation ports present -- - - - - - -- - - - -- ❑ ❑ • Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - --- - ❑ II ❑ Pump tank setbacks consistent with septic tank?-- -- --- -- -- - - ❑ NIA ® YES ❑ NO Y Pump tank capacity(flood) 1250 gal Manufacturer HB Precast Q24"access riser(s)and accessible from surface?- - - - ------ - -- ❑ ® ❑ ~ Alarm or Control Panel Installed? - - ------ - - - - - - - - - - - - - ❑ UI ❑ O Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - ❑ ❑- d Pump installed in ❑ Bucket or 1 On Block or 0 Other 1 Pump Make/Model liberty 290 S Floats or ❑ Transducer Tank draw down 3 in/min Pump capacity 67 gpm Squirt Height 6 ft Pump on time 1 min 7 sec Pump off time 6hrs Daily flow set at 480 gpd Updated BI21Q010 Mason County OSS Installation Report pg. 2 Parcel tt 319024100030 ABANDONMENT RECORD Were existing septic components abandoned as pad of this project? -- - - --- - - - - - - -- — YES Q NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - --- -- ❑� YES ❑ NO RECORD DRAWING This is a permanent record and must be accurate and deanlptlre enough to relocate In the need of maintenance activities and future development. Typical Record Drawings rvntaln D,alnseld a mammld orientation&layout sepncipump lank/canon North arrow,reserve aremseld existing and proposed buhdmgs.location of wells,wamdines. wells,observation ports,aeanoull and other maintenance access points. incomplete Record Drawings may create additional delays in final installation approval and related permits [Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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 1 further certify that all information contained on this I further certify that all information contained on this form and�aatttaached Record Drawing is accurate, form and attached Rec d i a te. V`- _ V — 9/2/26 Signature of Installer Date ', ' cj _ 0(p - 7-�= Andrew Lehman . L Printed Name of Signed ! 1 MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and * 1 +I.R retilt ' pptrn trt Np .1 Record Drawing on behalf of Mason County Public Health: Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updmed wdl¢o19 RECORD DRAWING (continued) 4!^,David Anderson From: DO NOT REPLY <noreply@masoncountywa.gov> Sent: Wednesday,August 19,2026 8:55 AM To: Environmental health Subject: 055 Inspection request for HESS,DANIEL&SARA- SWG2026-00023 Submittal request for: HESS, DANIEL&SARA Site Address:+n^"CLDEflDENY&T4M 161 SE We.115Wood Lcay Permit Number:SWG2026-00023 Parcel Number:319024100030 Installer Name:Andrew Lehman Installer Phone Number:3604704914 Installer Email Address:Washingtonsepticservice@gmail.com Designer Name:JIM HUNTER Designer Email Address:JIM@HUNTERSEPTICDESIGN.COM Inspection Request Date:2026-08-19 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 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. ttH ry tV o MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2026-00023 ADDRESS: 161 SE Wellswood Way PARCEL: 319024100030 DATE: 08/19/2026 � s7v '•t: ti 1 e1 HOUSE TO DRAINFIELD DRAINFIELD TO HOUSE i JT' LL.4 i J - H H ! � o 1 -u Ii l F I I k LCf�F i H m . n I � e tea' < w N ) �, U v � P ! I . .