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HomeMy WebLinkAboutSWG2025-00366 - SWG As-Built - 10/30/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2025-00366 Parcel# 123305000047 Applicant Name Nathan Datus Subdivision (Name/Div/Block/Lot) Applicant Address 120 NE Davey Jones PI City, State, Zip Belfair, WA 98528 Site Address 120 NE Installer Name Quality Septic- C. Hurley Davey Jones PI Designer Name Caliber Design- R.Bazzell INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑/ Repair CI Other System Type Gravity Bed Pretreatment Type__ >5 ft. from foundation? - _ _ _ -., >50ft. fromwells? - - _ - _ - _ - - _ - - + -- t \' ❑ Nia YES Y 1`_Ll� _ ❑ 0 NO Z >50ft. fromsurfacewater? - - - _ _ _ _ -- �� �? ❑ 0 ❑ Cieanout between building and tank? --__ _ _- 1_ 2�," �_J ❑ 0 ❑ It V Tank baffles present? - _ - _ _ - ®��jr / ❑ ❑ _ c, tl 24"access risers over each compartment\:.:� _ _ U 0 LLI Effluent filter installed?- _ _ _ _ _ _ _ -__-__��_ ❑ © ❑ Septic tank capacity(working) 1200 (@X' _\ ❑ 0 ❑ (existing)gal Manufac urer Unknown-Concrete 0 D box water level and speed levelers used? - _ _ _ J OO�O Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - -- ❑ N/A ® YES El NO OQCheck valves installed? - - - - - - - - - - - - - - I ❑ ❑ a Transport Line Size 4" ® ❑ ❑ Schedule/Class SCH40/3034 Bedrooms installed (check one) ❑ 2 0 3 >10 ft. from foundation?- - - _ _ _ _ _ _ _ - ❑4 0 5 ❑6 ❑Commercial/Other Q >100ft. fromwells?- - - - - - - - - - - - - - - - - - - - - - --- - - - - ❑ Nia AYES ❑ No J >100ft. fromsurfacewater? - - _ _ _ _ _ _ _ _ ❑ ❑ w ❑ Z >10 ft. from potable water lines?- - - - - - - - - - - - - - - - - - - . ❑ © ❑ Z >5 ft. from property lines and easements?- - _ _ _ _ _ _ _ _ _ - ❑ 0 ❑ i > 30 ft. from downgradient curtain/foundation drains? - ❑ 0 ❑ Drainfield level and observation ports present - - ❑ © ❑ Q Graveless chambers or ❑ Clean gravel used? (check one) ❑ I ❑ Proper cover installed over drainfield?- - - - - _ _ _ _ _ _ - _ Pump tank setbacks consistent with septic tank?- - _ _ _ _ _ _ _ _ _ - ❑ NJ ❑ ZPump tank capacity(flood) n/a N/a ❑ YES ❑ NO gal Manufacturer n/a < 24"access riser(s)and accessible from surface?- - - _ _ _ _ _ _ _ _ _ 0 0 El Alarm or Control Panel Installed? - - - _ _ - - _ - - _ - - - - - - - - -- Control Panel equipped with Timer/ETM/Counter - - _ _ _ _ _ _ _ ❑ El 0 ❑ a Pump installed in a 0 Bucket or ❑ On Block or ❑ Other 0 ❑ E Pump Make/Model — n/a I M n/a ,a Tank draw down n/a ❑ Floats or 0 Transducer in/min Pump capacity n/a --�gpm Squirt Height n/a ft Pump on time n/a Pump off time n/a Daily flow set at n/a gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - If yes, please describe: 0 YES NO Were all components pumped out and properly abandoned per WAC246-272A-0300? ® YES D NO RECORD DRAWING This is a permanent record and must be accurate end descriptive enough to re-locate In the need of maintenance activities and future development Drawings contain Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfeld,existing and Types a ee. wells.o servabon ports,cleanouts.and other maintenance access a n9 proposed installation buildings,approvalal and welly.walerfir�cy points. Incomplete Record Drawings may create adddional delays m final and related pemits SEE ATTACHED ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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. gnat re of Instal a Date ..y r KOthyto L1ici = .t, 1 Printed Name of Signee + f:f t ,i, MASON COUNTY PUBLIC HEALTH r;, , :: ' i The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public L t v L1 I LlCENSEDDEVC ER Health: 10(so /Z� �A. .% .A. ‘1.•%. •%4 10/15/2025 Date (stamp, signature and date) Signature of Environments Health Specialist THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated aatrzota 0 411 m b -v Z - - - - - - ---- - 76.00' - - -- - - 0 I O� I I -a I �C by o I CD I / m S D In / I, / ^cr, jS / o t O }-� 1 m \' �. 2 -Ec... 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