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Home My WebLink AboutSWG2024-00299 - SWG As-Built - 1/8/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION rantr er SWG 2024-00299 Parcel# 123204390130 e HUSON,JOHN 8 DEBORAH Subdivision (Name/Div/Block/Lot) ress 120 NE TIMBERLINE DR p BELFAI R,WA 985289632 Installer Name Franklin J Clark 120 NETIMBERLINE DR Designer Name Franklin J Clark INSTALLATION CHECKLIST E Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type OSCAR-XO2 Pretreatment Type >5 ft. from foundation? - --------- ❑NrA Eves ❑ NO >50 ft. from wells? ---- - - - - - - - - - "". ❑ ■ ❑ Z >50 ft. from surface water? - -- - - - - - -BEC 34 ❑ ■ ❑ Cleanout between building and tank? - - - ❑ E ❑ U Tank baffles present? --- -- - - -- - - By- - - - - -- - ❑ ■ ❑ a24"access risers over each compartment? - - - - - - - - -- ElE ❑ rW Effluent fitter installetl?- - - - - - - - - - - - - - - - - - - - - - - - - -- ■ ❑ ❑ Septic tank size 1200 gal Manufacturer Hagerman Precast O D-box water level and speed levelers used? - - - - - - - - - - - - - -- E NIA ❑ yes ❑ No 0O Manifold/D-box accessible from surface?- - - - - - - - - - -- - - - -- ❑ ■ ❑ mZ Check valves installed? - -- --- - -- - - - - - - - - ❑ ❑ E O Q 40 F Transport Line Size 1" Schedule/Class Bedrooms installed (check one) ❑ 2 E 3 ❑4 ❑5 ❑5 ❑Commercial/Other >10ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - -- E] NIA ■ YES NO >1 00 ft.from wells?-------------- - - - - - - - - - - ------ ❑ ■ ❑ W >100 ft.from surface water? - - - - - - --- - - - - - - - - - - - - - -- El ❑ EL >10ft. from potable water lines?- - - - - - - - - -- - - - - - - - - - -- ❑ ■ ❑ QZ > 5ft.from property lines and easements?--- - - -- ❑ ■ ❑ K > 30 ft. from downgradient curtain/foundaton drains? - - - - - - - - - - ❑ E ❑ Drainfekl level and observation ports present - - - - - ❑ E ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) ■ C33 Spec Sand Proper cover installed over drainfeld?--- -- - - - - - - - - - - - ---- ❑ E ❑ Pump tank setbacks consistant with septiclank? - - - --- - -- --- - ❑ N/A ■ yEs NO Y Pump tank size 1200 oat Manufacturer Hagerman Precast F24" access riser(s) and accessible from surface?-- - - - - - - - - - - - IL Alarm or Control Panel Installed? - --- - - - - - - - - - - - - - - - -- ❑ E Cl 2 Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ ■ ❑ 7 Pre Low Ndge d Pump installed in ❑ Bucket or ❑ On Block or E Other T«horoloies soecieranons rl Pump Make/Model LOT-30 E Floats or ❑ Transducer a Tank draw down N/A in/min Pump capacity 2.1 gpm Squirt Height N/A ft Pump on time 00/00/22 Pump off time 00/03/38 Daily flow set at 360gpd upa>�n,rzo,e Mason County OSS Installation Report pg. 2 Parcel p 123204390130 ABANDONMENT RECORD Were any existing septic components abadoned as part of this project? - - - - - ------- - - - YES . NO If yes, please describe' Were all components pumped out and properly abandoned per WAC246-272A-03009 - ---- - - - YES No RECORD DRAWING This Is a pemvrmm raoovt and must M sa intake and tlncrial Mouplr to rHl xte In Me Mead of frellmanca acevmes aM fuNn tlevabgrenf. Typical Rewxd Dral domain: Deadfall a manifold orlenlelion&layout,Septitlpump tank locabon,Nonn anarv,reserve doanfed.easi and proposed beltlinps,IocaHpn dwalk,venal wells,otaervail Irons,cleanoNa,and other mainnnande aoxss pang. InooninNe Real Drevnnps may create addidonal deleya in final assallaCm appwal and related Fermin. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with /certify that the system has been installed in accor- the sept/c 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 I further certify that all information contained on this I further certify that all information contained on this forrm�and attached Record Drawing is accurate. form and attached Record Drawing is accurate. VJiw^�-V�u�1 CD 01 Dec2024 Signature of Installer Date Franklin J Clark Pfinted Name of Signals MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and .1.a Record Drawing on behalf of Mason County Public Heal 01 Dec2024 �t(h�� Signature of Environm ntal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uW°mdamnma r Work assigned to: BLANK ONSITE SEWAGE SYSTEM INSPECTION REPORT 2522 GREENWOOD DR NE-Bremerton,Kilsap LONG KAITLYN BLAIS GENERAL SYSTEM TYPE:Pressure Red Mn ONpnfMY(GPnI: Lsa nee llon: Cunenllra etl ale: feet Fep ,Tse 8.M1 T-10 360.00 08111=23 STARTUP NO DEFICIENCIES NOTED 30000180001 Lot:Pressure Sye SITE NOTES Panel functioning es/No The panel has been setup to dose the system a maximum of d : Alarm mechanism functioning as intended: Yes/No I NA Pump 1:Arrival on minutes override in parenthennes,-If present): Pump 1:Arrival off hours loverride in parentheses-if present); Pump 1:Arrival gallons W dose override in parentheses-if sent: Pump 1:ETIV hours override in parentheses-if resent: Pump 1:Cycle Count(override in parentheses-if present): Pump l:Timer setting adjustments were required (if yes indicate new dinner settings Yes/No below-state reason in comments): Pum 1:New gallons par dose override in parentheses-If resent: Pump 1:New off hours override in parentheses-if present): Pure 1:New on minutes override in arerltheses-if resent: Effluent level within operational limits if NO explain in comments): Yes/No All required baffles in place NIA=No baffles required): Yes/No/NA Effluent Filter Cleaned NIA=Not Present): Yes I No/NA Compartment 1 Scum accumulation Inches,if otherspecify): Compartment 1 Sludge accumulation Inches Botherspecify): Compartment 2 Scum accumulation Inches if others i Compartment 2 Slud eaccumulation Inches Botherspecify): Pum in needed Me,/No Compartment 1 Scum accumulation Inches,if otherspecify): Cam artment 1 Sludge accumulation Inches,if otherspecify) Pum in needed. e,INo Cam onent appears to be functionimq as intended'. es/No Controls functioning: as l No Pump Vault Filter cleaned N/A=not present): Ves I No/NA Tested allons er minute flow: Com onent a ears t0 be fund ionin as intended'. Yes,/No Lateral lines Flushed: aS/No Average squirt height it performed) feet,if otherspecify) Pondin resent?BYES explain in comments: es I No I NA One or more laterals have been turned off II es explain in comments): es I No One or more laterals have been turned off fora period rester than 12 months: es/No Components accessible for service: ss I No All required service performed if no-specifyomitted inspection items in notes: es I No Surfacing effluent from an component mcludin mound seepage): es/No/NA Components ear to be watertight-no visual leaks: as Improper encroachment(structures/mperaous surfaces);cover, or settling problems es/No observed: Structures connected to onsite sewn e system oac.ilpledl.If NO explain in comments: es/No All deer lids secure fastened u on departure: es I No/NA Ins aed corn onems appear to be in Do d physical condition: es/No BnmsseswonDDReE_BMMWM, r Pags ion SYMBOLSLEGEND 0- 0 TREE-R-E. m O MTMLEIEA X— NARYPoLE 0 MMLW w MWWWAMS�YOW DM P pmPER uw -X- O z3e.... .......... -------- M n >Z CT o (D N (D 40 0 Designer's Stamp ek 0 'aR. .......................... .......................... 5i > + ff M M • -/+,OZL