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Home My WebLink AboutSWG2024-00016- ASBUILT - SWG As-Built - 6/15/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH Permit Number SWG 2024-00016 Parcel# 22213-77-00050 Applicant Name Summer Mielke Subdivision (Name/Div/Block/Lot) Applicant Address 250 E Johnson Ridge Dr City, State, Zip Belfair Wa.98528 Installer Name Richard Moore Site Address 250 E Johnson Ridge Dr Designer Name Rod Left INSTALLAflCNCHEGKLIST ® Full System Installation ❑Tank(s)Only O Drainfield Only ❑Repair ❑Other System Type Gravity Pretreatment Type • >5 ft.from foundation? ---- --- ---- - NIA ®YES ❑ NO >56.ft.fromwelis? ------ ---- --- - -------,- -— ❑ >50ft.fromsurfacewater? - -- - - - - - - - -206-- U J ® ❑ Cleanout between building and tank? - -- -- - - -- - ----- --- ® ❑ Tankbafflespresent? - - - - - - - - - - - - F By - --- -- IJ II ❑ _ 24"access risers over each compartment?- - - ---------- - tJ ❑ Effluent filter Installed?,- - - --- - - ---- - --- --- ---- -- - ❑ ® ❑ Septic tank capacity(working) 1250 gal Manufacturer Infiltrator D-box water level and speed levelers used? - - - ---- ------- - ❑ NIA ®YES ❑ NO Manifold/D-box accessible from surface?- -- - - - - -- -- -- - -- - CheckCheck valves installed? - -- - - - - - - - - - - - - -- - - - - -- - -- ❑ a Transport Line Size 4" Schedule/Class 3034 Bedrooms installed(check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >1Gft.from foundation?- - - - - - - - - - - - - - - - -- - - - -- - -- ❑ NIA YES ❑ NO >100ft.fromwells?-- -- - - -- - ---- ---- - -- - - - - -- - -- O ® ❑ >100 ft.from surface water? - -- - - -- - -- -- - - - - - -- -- - - - ❑ ❑ >10 ft.from potable water lines?-- - - -- -- -- - -- -- - --- -- - ❑ ® O >5 ft.from property lines and easements?- - - - - - - - - - - -- - -- ❑ I ❑ > 30 ft.from downgradient curtain/foundation drains? - - - - --- - - - ❑ ® ❑ ` Drainfield level and observation ports present - - - - - - - - -- - -- ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- ---- - - - -- - - - - ----' ❑ ® O : Pump tank setbacks consistent with septic tank?-- --- - ------ - ® NIA ❑ YES ❑ NO Pump tank capacity(flood) gal Manufacturer 24"access riser(s)and accessible from surface?-- - - -- - - -- --- ® ❑ ❑ Alarm or Control Panel Installed? - ---- - --- - ----- --- - -- - ® ❑ O Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - I ❑ ❑ • Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Pump Make/Model ❑ Floats or ❑ Transducer Tank draw down in/min Pump capacity gpm Squirt Height ft = °Pump on time Pump off time Daily flow set at gpd Updated 8!21/2018 Mason County OSS Installation Report pg. 2 Parcel# 22213-77-00050 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - -- ❑ YES Q NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-O300? - - - - - - -- El YES ❑ NO RECORD DRAWM 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,Septiclpump tank location,North arrow,reserve drainfield,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 OF1NSTALLATION 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 Re rd Drawing is accurate. form and attached Record Drawing is accurate. 28/26 Signature of Installer Date Richard Moore �w �� Printed Name of Signee W ' MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public INCENSE E z rr Health: r:XFIRco tzlt�i?x� I cf Signature of Environmenta Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2112016 N COUNTY Public Health & Human Services FINAL INSPECTION: SWG2024-00016 ADDRESS: 250 E Johnson Ridge Dr PARCEL: 22213-77-00050 DATE: 6/10/2026 HOUSE TO DRAINFIELD DRAINFIELD TO HOUSE ?4p, TOP OF S SO- SS �O. "N 100% RESERVE (TREATMENT LEVEL B O2y '$1002 m,� LIrFN 0 DESIGNER z E/.P F_S 12l15! . v to 3-BR HOUSE EXISTMG•• �,i•'?`f' '' '' DRN WA( APPROVED .•t. �� - _ ��'��y JUN 15 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET A 0 5'10' 30' 50' 75' 100' RECORD OF CONSTRUCTION SCALE(FEET) THIS IS NOT A SURVEY. ALL PROPERTY LINES/BOUNDARIES HAVE LEGEND BEEN DEMONSTRATED BY THE OWNER(S) = SOIL LOG AND/OR THEIR AGENT(S). �` E D E I N A yVl ---. NO BUILD ZONE * ALL MEASUREMENTS WERE TAKEN FROM KNOWN POINTS DEMONSTRATED BY THE PROPERTY OWNER. -' a CLEARING LIMITS DATE- 24 MAY 2026 BOX 2954 * ALL MEASUREMENTS WERE TAKEN WITH AN OPEN-REEL FIBERGLASS TAPE MEASURE. - TREES - 12•• DMA NAME- MIELKE SILVERDALE, WA. * NO FOUNDATION SPOILS OR BURNING ON DRAINFIELD AREAS. - 98383 * DUE TO UNFORESEEN WATER TABLES, A CURTAIN DRAIN MAY BE REQUIRED. (D = CLEAN OUT TAX ID- 22213-77-00050 * DIRECT ALL DOWNSPOUT/SURFACE WATER AWAY FROM DRAINFIELD AREAS. = 1200-GAL SEPTIC TANK STREET- 250 E. JOHNSON RIDGE DR TEL. 360-698-8488 * ALL TANK ACCESS COVERS ARE RISERED TO FINISHED GRADE. (D = D-BOX INFO@ACMESEPTIC.COM SCALE: 1" 50 � ROC 57626c I too, cos_ zao_ ass\ �JS I0DR R!!!RK (IRGTWIf ttVlL LICENSE NER G `_LiHryEWA�, EfP[7:69 121 i51 i.. O SRI w SV m 1w SCALE(FEET) ACME DESIGN `'•`: DATE- 24 MAY 2026 P.O.BOX 2954 NAME- MIELKE SILVERDALE, WA. TAX ID- 22213-77-00050 98383 STREET 250 E.JOHNSON RIDGE DR INTEL.FOa(ACMESE360-698-8488PTIC.COM SCALE: 1"=80 ROC 30.