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HomeMy WebLinkAboutswg2025-00409 - SWG Application / Design - 4/15/2026 s Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00409 Parcel# 222162200130 Applicant Name Madelyn Cataldo Subdivision (Name/Div/Block/Lot) Applicant Address 7350 NE North Shore Rd City, State, Zip Belfair, WA 98528 Installer Name Hemley's Septic Cleaning Site Address 7350 NE North Shore Rd., Belfair Designer Name Mike Jerkovich INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pressure Distribution Pretreatment Type >5ft.fromfoundation? -- -- - -- - --- - -- - - - - - - -- - - ❑ NIA DYES ❑ No >50ft.fromwells? -- - - - - - - - - -_ - 1- - - - - ❑ © ❑ >50 ft.from surface water? - - - - - - - - ❑ 0 ❑ Cleanout between building and tan -\ -' -- - - - - - - ❑ ❑ 0 L V Tank baffles present? - - - - - - - -1- �- ��'c� - - - - - - -.- - ❑ ❑■ ❑ t, d24"access risers over each compartm rat?- - -- - - - - - - - - - ❑ 0 ❑ W Efuentfilterinstalled?- - --- -- -- - - - - - ------- O ■❑ ❑ Septic tank capacity(working) 1000...: Manufacturer Roth 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑■ N/A ❑ YES ❑ NO �O Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - - ❑ ❑ r9 Check valves installed? - - - - - -- - - - - - - - -- - - - - - - - - - - ❑ ❑■ ❑ M Transport Line Size 2° Schedule/Class 40 Bedrooms installed (check one) ■❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ❑■ YES ❑ NO >100ft.fromwells?-- -- -- - - -- -- -- -- - - - - - - - -- - - - - ❑ ❑■ ❑ --� >100ft.fromsurfacewater? --- - - - - - - - - - - -- - - - -- - - - - ❑ 0 ❑ W U: >10ft.frompotablewaterlines?- --- - -- - - - - - - - - - -- - - - - ❑ ❑■ ❑ Q > 5ft.frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ ® ❑ > 30 ft.from downgradient curtain/foundation drains? - - - - - -- - - - ❑ 0 ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ 0 ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- -- - - - -- -- - -- --- - ❑ ❑■ ❑ Pump tank setbacks consistent with septic tank?-- ----- ------ ❑ N/A U YES ❑ NO Pump tank capacity(flood) 1060 gal atr Roth B24"access riser(s)and accessible from surface?-- --------------- -- - --- - ❑ IN ❑ t— Alarm or Control Panel Installed. ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ ® ❑ a- Pump installed in © Bucket or ❑ On Block or ❑ Other IL Pump Make/Model Liberty 290 ❑ Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 40 gpm Squirt Height 5 ft Pump on time 1 min Pump off time 4 hrs Daily flow set at 240 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 222162200130 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -- - -- -- - -- - -- - - 0 YES NO If yes, please describe: Decommissioned and hauled off 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: Drainfield&manifold orientation&layout,Septic/pump tank 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. © 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 ttached Record wing is accurate. form and attached Record Drawing is accurate. Sig ure of staller .-f,.-Date 14enie . .-.. Printed Nthne of Signee % .tioF MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation '. e ' 9' PP - 5100385 Record Drawing on behalf of Mason County Public °.MICHAELD.JERI(OYICH :.. Healt . Ar �� p "uCENSED DEsIGNER ((5 (7*s N 4A 4.7.26 fib, Si ature of Environmental Health Specialist Da / ? 6 Sig P � (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE F F)VBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2112018 OWNER RECORD OF CONSTRUCTION MADELYN CATALDO __ 7350 NE NORTH SHORE RD BELFNR,WA 98528 PARCEL #22216-22-00130 DRY Of51GNER PROJECT DATA PROJECT NAME:25105 CATALDD n t' PARCEL:22216-22-00130 SEPTIC SYSTEM SPECIFICATION i7,- SITE ADDRESS:7350 NE NORTH SHORE RD.BELFAIR ',M '::. %� 1. 1-2 COMPARTMENT 1060 GAL ROTH SEPTIC TANK. LEGAL DESCRIPTION:TX A OF TOO 11-12 OF GOVT / j 2. 1-1000 GAL PUMP CWJABER ROTH. 4.726 LOT 1 N PCL 5 OF ALA X94-106 1000566 % 3. 1-LIBERTY 290 EFFLUENT PUMP WRH FLOATS. 4. 1-MVP SIMPLEX CONTROL PANEL(MVP-S1DM) LOCAL JURISDICTION:MCHD % j 5. 1-ORENCO A'BIOTUBE EFFLUENT ALTER. N �rauc� LOT AF EN 0.48 ACRES(20.908.8 SF) 6. 50 LT OF 1.5 SCH 40 TRANSPORT UNE. i �-�-� 56i�'O.OS 7. 1-CARSON VALVE 80%SIZED APPROPRVTELY FOR VALVES. �4� 8. 3-1.25"BALL VALVES AND FITTINGS TO ACCOMMODATE 1.5"SCH % 1 40 PIPE. PROJECT DESCRIPTION ' \, 9. 135 LF OF 1.25"SCH 40 PIPE AND FITTINGS FOR LATERALS. 10.135 LF OF INFILTRATOR,INSTALLED OBSERVATION AND LITERAL 9/10/25 INSPECTION FOUND THE D-BOX HAS CLEANOUTS TO SURFACE. ROOT INTRUSION AND THE GRAINFIELD I$ ���f 11.ALL COMPONENTS OF THE SEPTIC SYSTEM WATERTIGHT TO THE Oo SATURATED AND NOT FUNCTIONING. % ":% I SURFACE. N _ :',rT;� 72.RISERS ARE ON THE SEPTIC TANKS AND PUMP CH4MBERS. LF3 o SETUP INFO SYSTEM SPECS - - TIMER ON:00:01:00 A•/ > iiiii A TRENCH WIDTH 3:/ / ' �� BM SPIKE WITH TIMER OFF:04:00:00 TRENCH LENGTH 3045' O O PINK FEATHER DRAYIDOWN:2 TRENCH DEPTH 18" Q IN TRENCH SPICING 5' CAL PER MIN.:40 L¢i EL 62' 3' '\ GAL PER INCH:30 J W O % DAL PER DOSE:40 DEPTH TO RESTR 12"LAYER 42" I, j,I DOSE PER DAY:6 DEPTH OF COVER 12"-18"MIN Q Lb N .l olo. SQUIRT HEIGHT:60- ORIFICE SIZE 3/16 N/ R100' `\ 't T _ DNLY ROW:240 GAL ORIFICE SPACING 48" CACLE COUNTER:7 ORIFICE TOTAL 01 36 cD �, I AA GREEN '1 4jm w N HOUSE N WELL HOUSE j II IVELL ,--;�'Cb O I Q Rs0' JJ SOIL LOGS 9/23/25 1'1 TEST PH-I(OVERALL DEPTH 6D")2 TYP 4 SOIL.6 APPLICATION RATE P' 1 \A o BEDROOM I 0-60"GRAVELLY FINE SANDY LOAM. O �l0 7 COMPACT GOOD ROOT PENETRATION TO 1n ,I \\ ( - 7 i BOTTOM. j — / TEST PR-2(OVERALL DEPTH 60") I TYP 4 SOIL.6 APPLICATION RATE / 0-60"GRAVELLY FINE SANDY LOAM. \ �� ' COMPACT GOOD ROOT PENETRATION 10 BOTTOM. •`•\ j TOP OF BANK � amrt rmuem:srm _ t369iE A-. X5.55.42 ;� aLv.�o�cemnox: wrc 1 SITE PLAN i : SCALE: 1" = 30 0 30 60 A5BUILT9UILT I I I I I OSS-5.0 ly