The URL can be used to link to this page

Home My WebLink AboutSWG2018-00440 - SWG As-Built - 9/15/2025 CLEAR FORM Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2018-00440 Parcel # 12206-13-90160 Applicant Name Dave Henninger Subdivision (Name/Div/Block/Lot) Applicant Address 130 Easst Razor Rd City, State, Zip Belfari, WA 98528 Installer Name Tom Weaver Site Address 19292 E State Rt 106; Belfair Designer Name Tom Weaver INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pretreatment to pressure Pretreatment Type NuWater BNR600 Poly >5 ft. from foundation? �t - - - ❑ N/A YES ❑ NO >50 ft. from wells? 1\�j-j%S - ❑ ❑ >50 ft. from surface water? - - - - - 1t 1-&+ti''i ' - - ❑ ❑ Z H Cleanout between building and tank. -sop- 0-92245-- - - - ❑ ❑ U Tank baffles present? - 1% - ❑ I ❑ d 24"access risers over each compart nt?---- - -- - ❑ ❑ W Effluent filter installed?- -.Y - ❑ IN ❑ to Septic tank capacity(working) 500 gal Manufacturer Infilltrator IM540 5 D-box water level and speed levelers used? - - IIIII N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ II mZ Check valves installed? - - ❑ I ❑ GQ E Transport Line Size 2 Schedule/Class SCH40 Bedrooms installed (check one) ❑ 2 III 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A III YES ❑ NO CI >100 ft. from wells?- - ❑ I ❑ W >100 ft. from surface water? - - ❑ II ❑ LL >10 ft. from potable water lines?- - ❑ IIII ❑ ierZ > 5 ft. from property lines and easements?- - ElII ❑ d > 30 ft. from downgradient curtain/foundation drains? - - ❑ e ❑ • Drainfield level and observation ports present - - ❑ 0 ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 1.1 YES ❑ NO Y Pump tank capacity(flood) 1,200 gal Manufacturer Infiltrator IM1060 < 24" access riser(s) and accessible from surface?- - ❑ ® ❑ H a Alarm or Control Panel Installed? - - ❑ El 2 Control Panel equipped with Timer/ETM /Counter- - ❑ ® ❑ m a Pump installed in ❑ Bucket or 0 On Block or ❑ Other a• Pump Make/Model Liberty 280 III Floats or ❑ Transducer a Tank draw down 21.65 in/min Pump capacity 33 gpm Squirt Height 4 ft Pump on time 1 min 45 sec Pump off time 4 hours Daily flow set at 360 gpd Updated E 212018 Mason County OSS Installation Report pg. 2 Parcel# 12206-13-90160 ABANDONMENT RECORD Were existing septic components abandoned as part of this project') YES ® NO If yes. please describe Were at components pumped out and property abandoned per WAC246-272A•0300? - - EI YES D NO RECORD DRAWING This I.a permanent record and most be accurate end descriptive enough to re-boat.in the need of malnl.nence activities and Mare development. Typcat Record Dra angs comer D a nseid a mar told on.ntalwn 6 layout.Sepb.'punp lank bacon Nonn arrow reserve dr.Mreld.misting end proposal bindings,location of wells,rNerfnes. weds obtervatror ports cleanouls and liar maintenance access points Incomplete Record Oravdngs may[reale adNtronal delays In Mal installation approval and Whaled permits See Attached EX 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 aecord Dra ing is accurate.:„.....z...., form and attached Record Drawing is accurate �--1"--`"10/14/2022 Signature of Installer Date / Thomas Weaver y�0—� Pnnted Name of Signee �//�.I b .. ijit I' MASON COUNTY PUBLIC HEALTH r� The undersigned approves this Installation Report and Sttm�9 t�.� Recoro Drawingon behalf of Mason CountyPublic TNOA11bi' E 1 N " ' bDE I N R �`: Heah •. 1 C111 q ((c1z 2 Signature of Environme tat Health Specialist Date (stamp, signature and date) THIS FORM MAv BE SCANNEC AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Uoes,r16/2•/2''d SL# 1 0"•21" Sand Loam 21"+ Silt Loam&Water Evident '- SL#2 0"•2S"Sand Loam N - eOIF 25"+ Silt Loam&Water Evident - c� SL#3 0"-32"Sand Loam fit' fee 32"+ Silt Loam&Water Evident S -- / - • , .' Ade, \ , s r r • Non•sevaic 3o. Atik Drivewr Eesement r0, i 19290 E Siete Now 106 / r • 701 55'+- 3 Bedroom House Envelope +27'ei • 31s•V / . d i i \ k( /a�� itcc 4 80'+• 4 III t... • ?' e.r ISie4.•(6.•‘ ..\ VA ' ✓ V :‘(// YR 4s w � "s33 I• I tiIiCAi.• _1..EPVFk %Pea::_ I.'..A1A DZ. ' 4 II ..11'11 Proposed Bused Power line , , �` .eve �f Ii 11 APPROVED '. ��'� /;�� 7% r i SEP 15 2025 ck.�o,,, ItiS I/ dr dp Q. MASON COUNTY ENVIRONMENTAL HEALTH t; % 4i RET '_ , +6o1ea, Allied Design,Inc. 'Site Plan" Scale = I" = 5n' Address: 19292 E State Route 106. Belfeir On Site Septic Mtn Name: Murphy Tax parcel # 12206-13-90160 This is note survey:ail property I Ines/boundaries have been demonstrated by the Owner(s)and/or their Agent(s).