Loading...
HomeMy WebLinkAboutSWG2026-00078 ASBUILT - SWG Application / As-Built - 5/19/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00078 Parcel # 22212-56-00005 Applicant Name VO, Bang Luong Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 809 Rose Point Tracts City, State, Zip Machester, WA 98528 Installer Name Darren Miller Site Address 80 E Rose Point LN Belfair WA, 98: Designer Name Dave Ghylin INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only IJ Repair ❑Other System Type Replace failed Bic --Pretreatment Type iiyooe6it. 1 r R—� >5 ft.from foundation? - - - - - - - - -- --� t ❑ N/A ®YES Li NO >50ft. fromwells? - - - - - - - - - - - — ,- fi26 ® ❑ ❑ >50ft. fromsurfacewater? - - - - - - 4--- - -- ------ - --- Li- - - -- - ❑ Z Cleanout between building and tank? - �r - - - - ---- - ❑ ® ❑ Tank baffles present? - - - - - - - - - - - - - - - - - ❑ ❑ 24"access risers over each compartment?- -- - - - - - -- -- - - -- ❑ ® ❑ `W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑■ Septic tank capacity (working) BNR-500 gal Manufacturer Nuwater 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ® N/A ❑ YES ❑ NO �O Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ® ❑ ❑ CO Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ® ❑ ❑ oa 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - -- - - - - - - - - - - - - - - - - - - ® N/A Li YES ❑ NO 13 >100ft.fromwells?- - - - - - - - - - - - - - - - - - - - - - - - - - - -- ® ❑ ❑ W >100ft.fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - -- ® ❑ ❑ >10ft.frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - -- ® ❑ ❑ Z > 5ft.frompropertylinesandeasements?- - - - - - - - - - - - - - - - ® ❑ ❑ > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - I] ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - -- ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - - - ® ❑ ❑ Pump tank setbacks consistent with septic tank?- - - - - - - - - - - - - ❑ N/A ® YES ❑ NO Pump tank capacity(flood) gal Manufacturer Existing < 24"access riser(s) and accessible from surface?- - - - - - - - - - - - - ❑ © ❑ a Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - -- - - - ❑ ❑ Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - ❑ 0 ❑ - Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Existing Pump Make/Model Existing ® Floats or ❑ Transducer Tank draw down N/A in/min Pump capacity gpm Squirt Height N/A ft Pump on time 5 min Pump off time 1 min off Daily flow set at demand gpd Updated 8/2112018 Mason County OSS Installation Report pg. 2 Parcel# 22212-56-00005 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -------------- - ❑o YES D NO If yes, please describe: Failed Biomax was pumped and removed. Were all components pumped out and property abandoned per WAC246-272A-0300? -------- R 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: Drainfleld&manifold orientation&layout,Septic/pump lank location North arrow,reserve drainrreld,existing and proposed buildings,location of wells,waterlines. wells,observation ports,deanouts,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 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 Drawing is accurate. form and attached Record Drawing is accurate. - ►8-Zoz� 'I gnature of Installer Date (Y/4 Darren Miller1, Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this installation Report en j <o 'y+ Record Drawing on behalf of Mason County Public Heal �SO49 o // 57I C Signature of Environmental Health Specialist QO (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAIABLE I OR PUBLIC VIEW ON THE MASON COUNTY WEB SRE updated 812112018 RECORD DRAWING (continued) A �gsoNc Mqy? N�yFNTQ`tiF 1 • • • .fir F . h t Kayla Milam From: DO NOT RI:I'I.Y •.noi�' rl I Y®masoncountywa,yov> Sent: Tuesday, May 12, 2026 11:33 AM To: Environmentalhealth Subject: OSS Inspection request for Darren Miller 2026-O007j; • ,, Submittal request for:Darren Miller Site Address:80 e rose point Permit Number:2026-00078 Parcel Number:222125600005 I MAY 1 2 2026 !' Installer Name:Kitsap Septic Pumping INC B�Installer Phone Number:360-871-5258 Installer Email Address:office@kitsapseptic.net Designer Name:Daves Septic Design Designer Email Address: dss9699@outlook.com Inspection Request Date:2026-05-12 Inspection Type:Tank(s)Only Comment\Notes:Air line was short and will be extended/replaced. Emailing pictures to Rhonda of bentonite around the middle seam of tank. Will send pictures of bentonite around risers and pipes at final backfill. Thank you for submitting your final install request.The install should be complete and ready to inspect on the 'Inspection Request Date'and remain uncovered for three business days to allow staff time to inspect. Poor weather situations may be accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backfill of system components. If no contact is made by the health department within the three business days of notice, the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation fee m be submitted for final installation approval. ust 1 15) Do not Damage Or Disturb Soils When Clearing Drainfield NOTE: Area ADDITIONAL FEES ARE REQUIRED CONTACT DESIGNER FOR DETAILS. Pump is required Pump alarm is required NO WELLS WITHIN 100'♦ URF�QLF�Y ` INSTALLER TO ENSURE ALL ON-SITE SEWAGE ALL COVER TO BE 5 5 MIN/INCH 1S TO qTF �% TANKS/COMPONENTS MUST BE WATERTIGHT TO SURFACE DIVERT ALL SURFACE WATER AWAY SURF9C�c FROM DRAINFIELD AREA. PREPARE SITE&INSTALL DRAINFIELD A�FK'gTF DURING DRY CONDITIONS DISCLAIMER This map does not represent a survey Normal usage must meet the following nor does it purport to show all easements or encroachments,if any criteria or be lower Biochemical oxygen demand 130-174 MG/L 1 / Additional Drains May Be Required To Divert Surface Or Subsurface Water Problems TSS: 47-71 MG/L FOG: 10-10 MG/L 4 DO: 0-1.0 MG/L PH: 6.5-7.2 OWNER: STUMP SPLITTING OR STUMP TEMP: 48-70` V O BANG L UONG GRINDING IS RECOMMENDED "With microscopic life forms present 80 E ROSE POINT LN FOR TREES GREATER THAN 12' � IN DIAMETER WITHIN DRAINFIELD "Higher waste strengths will result in AREA PROTECT SOILS WHEN CLEARING premature failure of the septic system. MASON COUNTY, V vA. O1 30, 60' TAX ID: 22212-56-00005 �.. ___ _____