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Home My WebLink AboutSWG2023-00079 ASBUILT - SWG As-Built - 5/26/2026 r Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG - '9" 00O—i- Parcel# 1i3 20- O.00 00 Applicant Name r- �`�_ Subdivision (Name/Div/Block/Lot) Applicant Address 10 3p `q5 City, State, Zip Installer Name \-w1/ - - -- e SiteAddress ® c R ( 4 ` esigner Name i Ic -k- INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type 6 6�Y IL_ Pretreatment Type >5ft. fromfoundation? -------- ----------- --- ----- ❑ NIA YES NO >50ft.fromwells? -- ------ - - - --- 0 ® ❑ >50 ft.from surface water? - -- --- E R - ❑ I ❑ Z Cleanout between building and tank? ------U ❑ ® ❑ Tankbafespresent? -- - --- - - - -MAY- U -- - - ❑ ❑ 24"access risers over each compart ent?- -- -- --- -- - ❑ ® ❑ W Efuentfilterinstalled?-------- -- - --- - ---- ❑ ❑ Septic tank capacity(working) 1,201 gal Manu at r TA t-},rrAoL. 0 D-box water level and speed levelers used? ------- -------- a NSA ❑ YES ❑ NO �O Manifold/D-box accessible from surface?--- ------- ------- ❑ ® ❑ DQ Check valves installed? - - -- --- -- --- ------ --- ----- ®' 0 ❑ �` r 2 Transport Line Size Schedule/Class 5cw (� Bedrooms installed (check one) ❑ 2 ❑3 0 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?-- ---- - ---- --- -- ---------- ❑ NIA YES 0 N >100ft.fromwells?---- ------------------------- ❑ ® ❑ W >100ft. fromsurfacewater?----- - ---- ---- - ------- -- ❑ ❑ Z >10ft.frompotablewaterlines?------------ ---------- ❑ ',] ❑ >5ft.frompropertylinesandeasements?----- - -- ------ - - ❑ ® ❑ >30 ft.from downgradient curtain/foundation drains?--- - - - - - -- 0 11 ❑ Drainfield level and observation ports present ---- -- - - ------ ❑ ® ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one)- N A Proper cover installed over drainfield?---- ---------- -- --- ❑ ® ❑ Pump tank setbacks consistent with septic tank?------------- a N/A ❑ YES ❑ NO Pump tank capacity(flood) 1 2bo gal Manufacturer 4ikccl3r -ewt Q24"access riser(s) and accessible from surface?------------- ❑ ❑ aAlarm or Control Panel Installed? ------- - - - -- ---- - - --- ❑ IN ❑ Control Panel equipped with Timer/ETM/Counter-- - - - - - - --- ❑ ® ❑ Pump installed in ❑ Bucket or ❑ On Block or ® Other Q4pr. oç4 e./s\ v\S eutk4 `D&≤ IL Pump Make/Model L kr AotA 11/A [I od,e(LoT 3b® Floats or ❑ Transducer a Tank draw down _ in/min Pump capacity 0 (\ gpm Squirt Height t'k/A ft Pump on time ZZ.Se.c-S Pump off time 3 a,n;ns $85er5 Daily flow set at 4& gpd Updated 8/21/2018 ( r Mason County OSS Installation Report pg. 2 Parcel# 02-01. 0-00006 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- ❑ YES ® NO If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? -------- ❑ YES NO RECORD DRAWING This is o permanent record and must be accurate and descrtptiva enough to ra•Iocats In the nand of malntonance activlllos and future development. Typal Record ma%ings contain: Drainfleld&manifold orientation&layout,Septicipump lank locatiort.North arrow,reserve drelnfleld,existing and proposed buildings,localton of wets.waledlnee, wets.observation ports.cleanouts,and other maintenance access prints. Incomplalo Record Drawings may create additional delays in final Installation approval and related perrnlls. 1z- I 3 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system In accordance with t 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 1 further certify that all information contained on this form and attached Record Drawing is accurate, form and attached Record Drawing is accurate. Signal staler Date Kor.Atm NvCk '4 . . Printed me of signed MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and rw,piy, j Record Drawing on behalf of Mason County Public Health: Signature of Environment I Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upa3leder2trt�te System Specifications OSCAR Inspection Part 18"+of soil depth.............. OS-50 Design Flow.............................r...... 480 gal/day Total Coils........................................ 8 8 4"Slip Cap Drill holes into Laterals............................................. 4 4 the ends of the Coils per Lateral............................. 2 4"Tee slip caps Dose GPM........................................ 2.8 2.8 P i Flush GPM........................................ 9.2 9.2 Excess TDH...................................... 50' 4"Tee with slip Min.Shoulder Length.................. 44.5' caps on the ends Basal Area:480 GPD/.6=800 sq/ft OSCAR X02-Parts List Basal Area Dimensions: 800 sq/ft=44.5'x 18' Use Lowridge OnsiteTechnologies 30 gpm,1/2 hp,\ 110 volt turbine pump,model LOT-30 Controller:LF1 P-RF-AR control panel Hi-Blow Aerator,HB-80(80 liter/minute) Hi-Blow diffusers OSX-4B0-55 O I 44.5'MIN.SHOULDER LENGTH • p T:: . !!! h S—c nA �AsoN coU�AY 16 2026 FNLn ViflUfENTA RETL HEALTH p uc'n-%7 OE _ .[ : /oos —•• I —----I� �> i 291.8+/- •---- — - EL65'+/ ED j , r.�..�--------------------------------------------------------------------•----••-------- ----------•-------•-----------------...--.-----------------------•-•---••--..._.......... -•-. •..., n5•+,- MAY 18 zp26 i 6o s 44.5'x 18'a600SgFt o IASOPd C0UPdTYEP,I�jR0 NEALTh E R T N E 44.5'x 18' 600 SgFt o ! o j pus O 65 Driveway �. ---------.-- ................................................................... ��o �o I 141' j .......... ... .... ----..............................•••............ 114' --•I 3 a 6100619 jFRM1l0lN J CORK 55 j05/02/2026 j I '� �� iM�.yn Paveftlne I A+ Opnsite, LLC , L✓,e j VYII�IIW 11d�I�90111tl1� i P.O.BOX 1954k 8&VHiDM.E WAGM 6.40 NE Old Belfair Hwy 1232050Q0003_ _ _ � '�'� 291.8'+/-� _"_••_.._.._.. ..= 3 � �i @_•/ Owner Name:Judy Scott XMH .I l 2Jla8 plo Submission Date: 02 May 2026 Re-Submission Date: Address:640 NE Old Belfair Hwy, Belfair WA 98528 SCALE: O 15 3O Tax I.D.: 123205000003