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HomeMy WebLinkAboutSWG2021-00408 - SWG As-Built - 3/16/2026 Meson County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT.INFORMATION : • Permit Number SWG 2021-00408 Parcel# 222115102008 Applicant Name John Rolland Subdivision (Name/Div/Block/Lot) Applicant Address 4960 NE North Shore Rd City, State, Zip Belfair,WA 98528 Installer Name Hemley's Septic Service Site Address 4960 NE North Shore Rd . Designer Name Mike Jerkovich ,IN:8 .=ALL: L'. . .- :: ' 0 Full System Installation O Tank(s)Only O Drainfleld Only O Repair O Other :',4n._`1 System Type Pressure Pretreatment Type a~ I>5 ft.from foundation? - - - O NIA is YES ❑ NO >50 - - -11%- 0 ® O ; � � ft"from wells? V ' �`'� >50 ft.from surface water? - � [] ® O :.'*,c: Cleanout between building and tank? - ��6 - ❑ 0 O ': •E'j: Tank baffles present? - t�-BAR - - . O ® O ,I ' 24"access risers over each compartmen ! - --- - _�------ O ® O I1.1: Effluent filter installed?- - y r:----4-- - ---- O 0 O ; y r. Septic tank capacity(working) 1001 gal Manufacturer Hagerman .4"':` D-box water level and speed levelers used? - - 0 N/A El YES O NO :gO: Manifold/D-box accessible from surface?- - O ® O �m��jfp Check valves installed? - © ❑ O f.tg :'.Transport Line Size 1.5" Schedule/Class 40 x °x,y` Bedrooms installed (check one) 0 2 ❑3 ❑4 O 5 ❑6 ❑Commercial/Other -.',W:'4 >10 ft.from foundation?- - ❑ NA 0 YES ❑ NO ; R� >1Q0ft.fromwells7- , " -P- - E- F(' ❑ O 0 W`: >100 ft.from surface water? - - O 0 O �_ >10 ft,from potable water lines? �� � i i ❑ Q ❑ t A MAR 1 6 2D..73 1 >5 ft.from property lines and ease a f.,?- I O ® O > 30 ft.from downgradient curtain/fhaMd�a�t(d�i-id anigli-QAMr-U;ALu _',�.y ❑ 0 O s: - Drainfield level and observation ports present - IT.7W' - 0 ® 0 :n:,-,1, ❑ Graveless chambers or ® Clean gravel used? (check one) ..1§',',.6''' Proper cover installed over drainfield?- - O ❑■ O '*'`'t':_ Pump tank setbacks consistent with septic tank?- - ❑ NIA El YES O NO . ::4,,..::'Pump tank capacity(flood) 1166 gal Manufacturer Hagerman iR 24"access riser(s)and accessible from surface?- - O 0 O viii,A;Alarm or Control Panel Installed? - O 0 O :103 Control Panel equipped with Timer!ETM/Counter- - O ® ❑ *1 Pump installed in O Bucket or 0 On Block or O Other '` i.1L, Pump Make/Model Liberty 290 III Floats or O Transducer -�S rta ' ,Tank draw down 1° in/min Pump capacity 20.4 Squirt`:���` p Y gpm q Height 3 ft In i Pump on time 2 min Pump off time 3 hr 58 min Daily flow set at 240 gpd Updated 812 112 01 8 Mason County OSS Installation Report pg. 2 Parcel# 222115102008 . - ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 0 NO If yes, please describe: 750g Septic Tank Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES El NO•...:.. ... : . . - .. :..`:.:Y::. ' RpoORD:DRAINING: .. . . . • 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: brainfleld&manifold orientation&layout,Septic/pump lank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays In final installation approval and related permits. ,:;!K_. p /anon r MAR 16 26��6 'fi 4 MASON COUNTY ENV1RONV A 1 MENTAL HEALTH It Record Drawing Attached w f��.�y{yp ....:..:.:,.. 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 informa • n contained on this 1 further certify that all information contained on this form an tached Recor► r- ing is ccurate. form and attached Record Drawing is accurate. ,i,l 2/18/2026 Sig ure of staller Date :% �J��. erg' .-(etc. Printed Na}Nahld of Signee f'r, of ) r - b.,.f2/ p.f. f�. MASON COUNTY PUBLIC HEALTH " *--b- The undersigned approves this Installation Report and R°mimes d�,.-..- Record Drawing on behalf of Mason County Public I.} C JOEL �13��O��sl�N�akft t�. ... �1 ea the 2/18/26 • k\ / 34(a-AP Si at r Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2112018 a y • OSS RECORD DRAWING - HARBORSTONE CONSUL= G,LLC PO Zia CIC Wag IIA MI5 INCYRIXICONEILLCOll PARCEL # 222115102008 OSS DESIGNER INSTALLED ITEMS • 1. 1- HAGERMAN 1000g 2 COMPARTMENT SEPTIC TANK. - - ----- ? k ------------ - 2. 1- HAGERMAN 1000g SINGLE COMPARTMENT PUMP .. -- - CHAMBER. •. 3. 1- ORENCO EFFLUENT (4" BIO TUBE) ',te °=• N89'41'00"W 4. 1- LIBERTY 290 EFFLUENT PUMP 2/18/26 -_ _ 5. 1- RHOMBUS IFS CONTROL PANEL. 1 6. 10X30 SAND LINED (C-33) BED OF INFILTRATORS 59.00' 1 (LOW PRO) WITH OBSERVATION PORTS HIKE JEAKONCH I 7. 90 LF 1.25" SCH 40 PRESSURE LATERAL WITH uJERKoxCF1Q}U Q00TQNEuccau _ OBSERVATION/CLEANOUT PORTS. wA 0000000 UCEHSE#:5100355 8. 10 LF 1.5" SCH 40 TRANSPORT LINE. 1 9. 1- VALVE BOX 10. 3 BALL VALVES \ SETUP INFO N 1 TIMER ON: 2 MIN 1 I) TIMER OFF: 3.58 HR OO DRAW DOWN: 1 IN al I GAL PER MIN.: 20 I GAL PER DOSE: 40 DOSE PER DAY: 6 \ SQUIRT HIGHT: 36" DAILY FLOW: 240 GAL EX. CYCLE COUNTER: .00052 SHED HR METER: .96 1 EX.WELL SYSTEM SPECS LL HOUSE \ Z BED WIDTH 10' —I \ E N BED LENGTH 30' Z �J_J \VV/// o i TRENCH DEPTH 12" Ca OD1 DEPTH TO RESTRICTIVE LAYER 24" J U 1 . FROM SAND SOIL INTERFACE _I Q DEPTH OF COVER 12-18" O J GRAVEL ORIFICE SIZE 3/16 �..�/ DRIVE/PARKING r� 1 ORIFICE SPACING 36" c:e 1 1 1 J N ORIFICE PER LATERAL 9 TOTAL OF 27 co EX. GARAGE O 1 O WOOD 1R75' / z T- FENCE �_ Ex. , �'` SOIL LOGS DATE 6/18/21 (r)CONCRETE r1 PATIO 1 TEST PIT-1 (OVERALL DEPTH 48") TYP 4 SOIL .6 APPLICATION RATE EX. 2-BEDROOM SFR OVER TYP 1 SOIL 1.0 APPLICATION RATE 1 0-24" LOAMY FINE SAND WITH ROOTS (TYP 4 SOIL) O 1' 24"-48" COURSE SAND AND GRAVEL (TYP 1 SOIL) CONTROL w PANEL 1 THE NEW SYSTEM WILL BE ACCESSING THE TYP 1 SOIL z _ - I WITH 24" OF C-33 SAND, THE C-33 WILL BE PLACED 6" INTO THE TYP 1 SOIL AND COME UP 24 FROM THERE. 100. ' " tp • O° ROAD01 O ;= ' DRAINAGE _k` MAR:Nr.Vi.IR°ONIVIUEUNTAELH:: 1 6 2026 1.4A �� �� MASON COUNTY PROJECT NUMBER:21059 ISSUE;RECORD DRAWING . DAIS 2/16/2026 l '° OVERALL OVERALL SITE PLAN 1 SCALE: 1" = 30' 0 30 60 ASBUILT I I I OSS-5.0