Loading...
HomeMy WebLinkAboutSWG2025-00299 - SWG As-Built - 10/1/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2025-00299 Parcel # 222222100300 Applicant Name James Sandburg Subdivision (Name/Div/Block/Lot) Applicant Address 14911 E ST ROUTE 106 City, State, Zip BELFAIR, WA 98528 Installer Name BayShore Septic Sewer Water Site Address 14911 E ST ROUTE 106 BELFAIR. Designer Name Adam Hunter INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only, 0 Repair ❑Other System Type Oscar - treatment Type N/A >5 ft.from foundation? - - .-2 ❑ N/A 1 YES El NO >50 ft. from wells? `.� • ❑ II ❑ • >50 ft.from surface water? - �`-' �`te ❑ 00 Z HCleanout between building and tank? - --,eQ - - - - -- 0 ❑ ✓ Tank baffles present? - -- - - - ❑ 0 ❑ 0~. 24"access risers over each compartment? - ❑ I ❑ `W Effluent filter installed?- -IA •- ❑ ❑ Septic tank capacity (working) 1500 gal Manufacturer infiltrator 0 D-box water level and speed levelers used? - - IN NSA ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - ❑ al ❑ 00 Z Check valves installed? - - ❑ 0 ❑ Q 2 Transport Line Size 1" Schedule/Class SCH40 Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ NIA IN YES ❑ NO >100 ft.from wells?- - ❑ 0 ❑ o W >100 ft.from surface water? - - ❑ Ell IT >10 ft.from potable water lines?- - ❑ ® ❑ Qz > 5 ft. from property lines and easements?- - ❑ © ❑ Q: > 30 ft.from downgradient curtain/foundation drains? - - ❑ NI ❑ Drainfield level and observation ports present - - ❑ IPI ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO Pump tank capacity(flood) '1�9QO tl gal,4 Manufacturer infiltrator < 24"access riser(s) and accessible from surface?- - ❑ © ❑ H a Alarm or Control Panel Installed? - - ❑ 1] ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ m n- Pump installed in © Bucket or ❑ On Block or ❑ Other a Pump Make/Model MCDONALD 30GPM#22050E2AJ 0 Floats or ID Transducer 0. • Tank draw down N/A in/min Pump capacity 321 gpm Squirt Height N/A ft Pump on time 22 Pump off time 4 Daily flow set at 240 qpd Updated 8/212018 Mason County OSS Installation Report pg. 2 Parcel# 222222100300 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES ❑ NO If yes, please describe: EXISTING SEPTIC TANK(ABANDON PER CODE) 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 descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record Drawings contain: Drainfieid&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainrield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may creato additional delays In final Installation approval and related permits. ❑ 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 1 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. (----...4"\Ar_________ 9/15/2025 Signature of Installer Date ::{ G ml: Brandon Thompson f� R)z S'z c- Printed Name of Signee f .. r` MASON COUNTY PUBLIC HEALTH The undersigned approves this Installatiortl O rti,ail 0 � ,;' ;. ..' A Record Drawing on behalf of Mason County Public ��� �`: . ,r;;.I'.,I l+ut,,t. Health:i27.____, OCT i•,.•f.,,,..1.,•;,.1. G V l! /U7hI coup),EN'✓IRO, MENTAL Signature of Environmental Health Specialist Date L),JA HEALTH (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 • \N 0 D r m n CT 0 \o i7er+ c\\ .... Ml V■ --__-�, w, �o m 0 (5) FF V , W 0 0 0 0 0 0 0 0 0 0 0 a O o o X X 'Do m X X O D =• n r D 0 G) XO _1 G) = 7�) I - m _1 O D z N aa. we D D o K v C -i m CO ..le. o _i < m r o 55 o n O m D - 0 m m n n C O y m 1- 1- D D -1 v D Z 0o 0 p K 0 O -I p cn ro \ m- m O mD 0z m -o Z w ,o m . • XI O -71 o -1 mZ X) Z ° m I- m m 0 II <Xm ' m p .' K r r 1 m z o o � op e °i ce � m „ o A o O D m / D - • . m v'l x D 0 X X m D O x o p To m 0 D m 0 m m_ Z > r ]J O m it n z 04 N a NJ CO 0 z o D O 0 _ O o < a O 70 0 0 Nix C m o cn m z j N '-3 0 0 23 cn rri (n C rn r- r Z --I * —= 70 I M o c, N Z z M D h� z m G) D U) n ✓� �, 0 Cn D -� 3 CO Cip O n 0 l 1 m m in n ••�•�rF r- D Dr A Z C7 r Ci:? •`,.•r.. % yamJ p p r- D (n CD �. ..r i m m 70 D O D z O �29 f 4. D 1- O X C7 c A .- .$) o 1,3 m D - m D o �� (N T. c, •31 rJ 00�� cn rV �/ m ~ D. r-