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Home My WebLink AboutSWG2025-00216 - SWG As-Built - 7/10/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00216 Parcel # 222215300002 _ Applicant Name Kellie McIntyre Subdivision (Name/Div/Block/Lot) Applicant Address 31 NE Lorrain Ct Lot 2 -Top of Hill -Twanah Falls ADD 10 C City, State, Zip Belfair WA 98528 Installer Name Korbyn Hurley n r—o n m_ Site Address 10 E. Snowcap Drive Designer Name INSTALLATION CHECKLIST601 _ ❑ Full System Installation ❑■ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Gravity Pretreatment Type N/A >5 ft.from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft.from wells? - - ❑ 0 ❑ Z >50 ft.from surface water? - - El El HCleanout between building and tank? - - El0 ❑ U Tank baffles present? - - ❑ 0 ❑ 1- 24" access risers over each compartment?- - ❑ 0 ❑ a W Effluent filter installed?- - ❑ 0 ❑ cn Septic tank capacity (working) 1000 qal Manufacturer Roth CID-box water level and speed levelers used? - - ❑� NIA ❑ YES IIINO D 0 O Manifold/D-box accessible from surface?- - ❑ ❑ O I Check valves installed? - - ❑ ❑ El thQ 2 Transport Line Size N/A Schedule/Class Bedrooms installed (check one) ❑■ 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑l N/A ❑ YES ❑ NO 0 >100 ft.from wells?- - 0 ❑ El J >100 ft.from surface water? - - El ❑ ❑ W LL >10 ft.from potable water lines?- - 0 ❑ ❑ Z >5 ft.from property lines and easements?- - � ❑ ❑ a ® ❑ ❑ � >30 ft.from downgradient curtain/foundation drains? - - CI Drainfield level and observation ports present - - II ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 El ❑ Pump tank setbacks consistent with septic tank? - - 0 N/A ❑ YES ❑ NO • Pump tank capacity (flood) gal Manufacturer Q24"access riser(s)and accessible from surface?- - ❑� ❑ ❑ H a Alarm or Control Panel Installed? - - 00 El 2 Control Panel equipped with Timer/ETM/Counter- - ❑■ ❑ ❑ n a- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other N/A d• Pump Make/Model N/A ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 222215300002 ABANDONMENT RECORD WPM existing ceptic components abandoned as pad of this project? • - E] YES NO If ves. please describe. Pumped and decommissioned existing tank, new tank installed Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES I] NO RECORD DRAWING TTrhr 1s a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record Drrnvkupa contain Drainfleki R manifold nrtentntlnn d layout.Septic/pump tank location.North arrow,reserve drainfield,existing and proposed buildings,location of wells.waterlines. wefts,observation ports,deannuts and other maintenance access points. Incomplete Record Drawings may create additional delays In final Installation approval and related permits. rh RTM C>> P 4 - vJ pNy f.( �f Ivcnl c! cb' tiff 5 034 Irtili.# ji 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 certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. i 6-30-25 Signature of Instal er Date Korbyn Hurley Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: '7( Signature of Environmental Health Specialist Date (stamp. sigratufe and doer THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC V EW ON THE VASO'N OXJtTt'I/tR• 5'7 '40""'e4'"n s MINI\ II l_, 10ESnow X141 _ — m2100.o.oe Sr,.eexh rewk.iu 10ESn 0 , North ® Drive NOTES: Way •Orenco biotube effluent filter to be installed on outlet baffle '/ •Cleanout to be Installed between house and proposed septic tank 15 ft Drain field ;� 80 ft long Roth' RMT1060 2 compartment existing OSS septic tank to be installed Red line signifies newMEM •Tank to be 5 ft nff foundation connection-8 ft from 0-Box foundation to tank- •Connect outlet of septic tank to 4 inch 3034 / existing OSS 5 ft to tank 'Old tank removed off property 4ftx11 •nkm2' 4 2232151t.._ 222215300003 10f SNOW DR • 2t2t1.2.00.4 IY RMT1060 Tank Specs Included 30E ssov $41 8 MYNN2H FALLS DR w/orenco effluent filter Quality Septic&Excavation SS7 E 1WAN:H FALLS DR installer:Korbyn Hurley PH:360-265-9062 Customer Info: -Lelgha Campbell 10 E.Snowcap Drive Belfair WA 98528 -,422.N747]7SDgnu I S Boa*,of Lend Men 5T. en;E.n CA /4 w F , , Fyl9l y�!lti