The URL can be used to link to this page

Home My WebLink AboutSWG2025-00034 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG Zozj -.000 34 Parcel # j'z--t-04,y`-6k.I.Yc7I?- Applicant Name 04 Afir-14,r-.) ylec,, 1 Subdivision (Name/Div/Block/Lot) Applicant Address y f i 1 p''., c4 P'- City, State, Zip Gt;y ft.-b-, + 9(13`Z- Installer Name Ge-A-I-MA-Y/rsd ilWe"kArA Site Address l fp4/ t ST' R�U-4, (c9Ci, Designer Name r16 01-e- INSTALLATION CHECKLIST ❑ Full System Installation ,a/nk(s)Only El Drainfield Only ❑ Repair 0 Other System Type & C�e7---- Pretreatment Type Nu pLeff- >5 ft. from foundation? - - El NIA N/A g YES ❑❑ NO ! >50 ft. from wells? Z >50 ft. from surface water? - - ❑ ❑ HCleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - - 0 iin 0 d 24" access risers over each compartment?- - El 'V] El W Effluent filter installed?- ❑ 11 ❑ u) Septic tank capacity (working) 1'"7--� 3 gal Manufacturer gaDrti pC adz CI D-box water level and speed levelers used? - - ❑ N/A ❑ YES OLL ❑ 0 ❑ N O Manifold/D-box accessible from surface? El Check valves installed? - - ❑ 0 ❑ N a OQ ;J�FiN ,J Transport Line Size �`'f ° S Schedule/Class `�� o IV1-_]Bedrooms installed (check one) 2 (�3 ❑4 ❑ 5 ❑6 ❑Commercial/Other 52L., >10 ft. from foundation?- � - 0 N/A El YES 1 El Ng ;3 CI >100 ft. from wells?- `-i" 0 ❑ ❑ W >100 ft. from surface water? - - 0 El u. >10 ft. from potable water lines?- - 0 ❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ El El d > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ ❑ o Drainfield level and observation ports present 0 ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ❑ 0 Pump tank setbacks consistent with septic tank? - - 0 N/A g1 YES ❑ NO • Pump tank capacity(flood) 164-0 gal Manufacturer I T 1`f- • 24" access riser(s)and accessible from surface?- - 0 rg ❑ H d Alarm or Control Panel Installed? - - ElEl 2 Control Panel equipped with Timer/ ETM /Counter- - ElElm a Pump installed in ❑ Bucket or 0 On Block or gOther (<71-4,- --) /"( ete_re--y-- d Pump Make/Model t-4--1 T'"46 µyd/,wk. HI-' 0 Floats or grTransducer 2 on Tank draw down /4•rl i mi Pump capacity /I gpm Squirt Height /-/ 4 ft Pump on time /3 C.-a-c- Pump off time re? 0-«'u Daily flow set at 4 0 gpd Updated 8,21f2018 Mason County OSS Installation Report pg. 2 Parcel# ( 2 Z6)(a S 490C9 2( ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - t YES 0 NO If yes, please describe: fa,--tp 4 LA - Y 'fe--S 1.�(o kf eta f$.s' Were all components pumped out and properly abandoned per WAC246-272A-0300? - - DYES 0 NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield.existing and proposed buildings,location of wells,waterlines, wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 7Fe -."1-1.7"OVGC4 C�f) record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that I 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 I further certif hat all information contained on this I further certify that all information contained on this form and ched Record Drawing is acc rat . form and attached Record Drawing is accurate. rye nature of Installer Date /// T N Ocrte,—S ✓ Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health:?'-----15\-)J nme n/� i'iO''' (. - Signature of Enviro tal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21,2018 i ' 90L—EIS '9 1988L oW ; wz i in $0.,,Z1.4e‘ n - 3IblvVO aN V V r IL Inct I o. o o Si 5 N Z N -cal gii 1 (/) „ot O r l t �.a ,• \.J W 1tI 0 thl AO '.. .,. 9ei. a 4,0 . CC. ccw 1 d ': o /i .s\s' '''1/4t..;-..' b m \\ a.'�Nt• .�ti'.'.�'•ir.`SFr•. r , 40).„,„„,44p,„ .: Inn i ,/c.......:.., IV -.. ‘ .._, •1114k‘ . ...."..-z, N.%4 .... ...,-„,;„- . V.' 4"-?::.,,- 7,;&. i / Nik., ; .--:'-i :. s 47-1 1: Yip \/ �a .. ..-,. ..o}:•^ S / ,),„ 4g(44 - -‘4**41 Ilk -; I /A#V/1/4,--;-. . 416.1 130 ci .N. •••\ II II AM -. .11/ \ Li; /()1()/ibi/ 7 vh 4/Nib •'................ za _/cy 0��"l U 0 8 ql t -' t t _ C� y�lTy It C p R (n r '= ‘p 0 �y KLot n C Q i .� W S' - ` L.,.. z z a. J g. 6 S TANK PUMPING REPORT Sits Nam*: Location: 18861 State Route 106 Service Company: Belfair Tax ID: 122065000012 KURT'S PRE-CAST Use: P.O.Box 99 Belfair,WA 98528 360 275-1996 Serviced:04/30/2025 by: Kurt Olson Submitted 05/10/2025 by:Kurt Olson Dump Location:Blo-Recycling Jurisdiction ID:122065000012 COMMENTS TANK:Pump Tank,Manufacturer-Glendon BioFilter Technologies,Inc.-M-31 Tank Pumped: YES Tank Size(Gallons)(Number only,no text): 1000 Effluent level within operational limits(if NO explain in comments): YES Total Gallons pumped from tank(Number only,no text): 500 Tank depth below grade(inches): 60 Access Risers installed to grade(N/A if not present): YES Tank Construction Material: Concrete Tank Condition Good: YES Effluent screen cleaned(N/A if not present): N/A Effluent surfacing around site components(N/A if not checked): NO Pump operating as intended: YES Controls operating as intended: YES Alarm working as intended: YES Tank abandoned after pumping: YES Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment 1 Scum accumulation(Inches, if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 4 TANK:Septic Tank-2 Compartment. Manufacturer=Glendon BioFilter Technologies,Inc.-M-31 Tank Pumped: YES Tank Size(Gallons)(Number only,no text): 1000 Effluent level within operational limits(if NO explain in comments): YES Total Gallons pumped from tank(Number only,no text): 1000 Effluent returning back into tank after pumping: NO Tank depth below grade(inches): 60 Access Risers installed to grade(N/A if not present): YES Tank Construction Material: Concrete Tank Condition Good: YES Baffles in good condition(N/A if not present): YES Effluent screen cleaned(N/A if not present): N/A Effluent surfacing around site components(N/A if not checked): NO Tank abandoned after pumping: YES Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment 1 Scum accumulation(Inches, if other specify): 4 Compartment 1 Sludge accumulation (Inches,if other specify): 24 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 10 edia Filter:Biofilter,Manufacturer Glendon BioFilter Technologies,Inc. -M-31 This tank was not pumped or serviced. edia Filter:Biofilter,Manufacturer-Glendon BioFilter Technologies,Inc.-M-31 This tank was not pumped or serviced. edia Filter:Biofilter.Manufacturer=Glendon BioFilter Technologies,Inc.-M-31 This tank was not pumped or serviced. This report indicates certain chamctenstics of the onsrte sewage system at the tune of visit.In no way is this report a guarantee of operation or future performance. ReportiD:802532 View pump reports online at www.onlinerme.com Page 1 of 1