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Home My WebLink AboutSWG2024-00477 - SWG Application / As-Built - 5/15/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC-HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00 W -11 Parcel# 223097600170 Applicant Name CHRIS WEISHAAR Subdivision (Name/Div/Block/Lot) Applicant Address 1872 NW VAA RD TR 17 OF SURVEY 12/34 City, State, Zip POULSBO WA98370 Installer Name JOHN GILLILAND Site Address 20 NE MUNSON CT W BELFAIR,WA 98528 Designer Name Jim Zimny INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pump To Gravity Pretreatment Type >5 ft.from foundation? ---------- -. ❑N/A ®YES ❑ NO >50 ft.from wells? ------ ---- L5�v - - - ❑ 0 ❑ >50ft. fromsurfacewater? ------ ----- - O ® ❑ Cleanout between building and tank? M _ D— - ❑ ii ❑ U Tank baffles present? - - - ----- - -- - - - - - --- - ❑ [U ❑ 24"access risers over each compartm - - -- - ❑ ® ❑ WEffluent filter installed?-------- ------ ---------- --- ❑ ® ❑ Septic tank capacity(working) 1250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? --------------- [U N/A ❑YES ❑ NO DO Manifold/D-box accessible from surface?----------------- ❑ ® ❑ Qz Check valves installed? -- --- ------ - ----- - --- ----- ❑ UI ❑ 7 Transport Line Size 2" Schedule/Class Sch 40 Bedrooms installed (check one) ❑ 2 ❑3 0 4 ❑5 ❑6 ❑Commercial/Other >10ft. fromfoundation?----------- --- --- --- ------ NIA UIYES ❑ NO >100ft.fromwells?--------------- -------------- ❑ LU ❑ W >100ft.fromsurfacewater? ------------------------ ❑ ® ❑ E: >10ft.frompotablewaterlines?---------------------- ❑ ® ❑ Z >5ft. frompropertylinesandeasements?---------------- ❑ ® ❑ 9 >30 ft.from downgradient curtain/foundation drains?--------- - Drainfield level and observation ports present ----- --------- ❑ LU ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ ® ❑ Pump tank setbacks consistent with septic tank?------------- ❑ NIA ® YES ❑ NO Pump tank capacity(flood) 1250 gal Manufacturer Hagerman Z Q 24"access riser(s)and accessible from surface?----- -------- ❑ UI ❑ . Alarm or Control Panel installed? --------------------- ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter - - ---- ---- ❑ ® ❑ a Pump installed in ❑ Bucket or ® On Block or ❑ Other fL Pump Make/Model Liberty 280 ❑ Floats or ® Transducer a Tank draw down 2" in/min Pump capacity 60 gpm Squirt Height 1' ft Pump on time I min 10 sec on Pump off time 4hrs Daily flow set at 360 gpd Updated 812112018 1 7 fl Mason County OSS Installation Report pg. 2 Parcel# C 2' 7(€GO 1 7 O ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - ------------ -- O YES ❑ NO If yes, please describe: 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 re4ocate in the need of maintenance activities and future devetopmenl Tynicat Record Oraw:ngs contain Ora nfield&mavfold orientation&layout.Sec@cIpump lank Ixatan North amour,reserve drainf-etd.existing and cr000sed buad:ngs.location of wets waterlines wets,observanon parts,dennouts,and other rranlerance access pcaits. Irwin late Record Drawings may crease addrxinal delays in final installation approval and related permila. 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 attached Record Dr�win 'is accurate, form and attached Record Drawing is accurate. nature of Installer Date Printed Name of Signee MASON COUNTY PUBLIC HEAL4 G. . lr ''" 2� The undersigned approves this Install Reply nd Record D wing on behalf of Mason Couit ,PubV' tYl�• _9 7 123033 ��1� Healt �, t o srlkn7,lmmf /°/'�t� �`� LICEN EO DESIr,NER Signature of Environmental Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR t pLIC VIEW ON THE MASON COUNTY WEB SITE ua=n:e!a?112018 As -Built �— County Stamp 50' Radius el 462' 70' TH#3 F' Resery 1 ' / N proposed 1 1480 '�y2l� �_ Rner am 4 0.0}� J° h .5,0"Atten'uafiorl �J�O � VTA�y home ° Zone I �� 1 :Designer Info: Jim Zimny 7178 Windflower PL NW Seabeck,WA 98380 ' o APDdesigns@icloud.com Applicant Info: \ CHRIS WEISHAAR NE MUNSON CT BELFAIR WA \` I 223097600170 ��•.� ��_ Power -_...�..._...—..._..._...._...�.. —• I Date: ~1� — 5/15/2026 _.__.. el 37 I Page Scale 1" = 50'