Loading...
HomeMy WebLinkAboutSWG2026-00100 - SWG As-Built - 7/2/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00100 Parcel # 222025402011 Applicant Name Sandra Lea Fredricksen Subdivision (Name/Div/Block/Lot) Applicant Address 9304 23rd Ave NW City, State, Zip Seattle, WA 98117 Installer Name Quality Septic- Korbyn Hurley Site Address 31 NE Wagon Wheel, Belfair Designer Name Caliber Septic- Richard Bazzell INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type ATU to Pressure Bed Pretreatment Type NuWater BNR500 >5ft. fromfoundation? - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ❑■ YES ❑ No >50ft. fromwells? - - - - - - - - - - - - '-�EPW A ❑ 0 ❑ >50ft. fromsurfacewater? - - - - - - -H ❑ 0 ❑ Zbuilding -11111 1202 - ❑ ❑l ❑ Cleanout between and tank? - - U Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - ❑ El Li F- 24" access risers over each compartmen B)- - - - - - - - - - ❑ El ❑ W Effluent filter installed?- - - - - - - - - - - - - - - - _ - - - - - - - - ❑ ❑■ ❑ N Septic tank capacity (working) gal Manufacturer NuWater BNR500 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑■ N/A ❑ YES ❑ NO �J O Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - -- - - - - - - - - - ❑ ❑■ ❑ IX Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ El ❑ 04 2 Transport Line Size 2" Schedule/Class 40/3034 Bedrooms installed (check one) 12 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ❑■ YES ❑ NO >100ft. fromwells?- - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑■ ❑ —J >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑■ ❑ W M >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ ❑l ❑ ? > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ II ❑ Q ( > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - ❑ ■❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ 0 ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - - - ❑ ❑E ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ❑ N/A ® YES ❑ NO Pump tank capacity (flood) 1250 gal Manufacturer Hagerman Precast Q24" access riser(s) and accessible from surface?- - - - - - - - - - - - - ❑ ■❑ ❑ ❑ © ❑ Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - ❑ ■❑ ❑ - Pump installed in ❑ Bucket or ❑ On Block or ■❑ Other High Head Pump Enclosure Pump Make/Model Orenco/PF5005 ❑l Floats or ❑ Transducer a Tank draw down 1 in/min Pump capacity 24 gpm Squirt Height 5 ft Pump on time 1 min Pump off time 2.4 hours Daily flow set at 240 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? If yes, please describe: - - - - YES NO 1 � t'c 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 deecriptive enough to n-locate In the need of maintenance acWkNs and future devNo Drawings contain. Dralntield&manifold orientation&layout,Septid preen. Typical Record pump tank location.North arrow,reserve draiMkld,existi g and proposed buildings location of wells,walerfines, wells,observation pats cieanouts,and other maintenance access points Incomplete Record Drawings may create additional delays in final inslallatinn a per mits and related Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with /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 /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. Signature of installer Date oçbn \ Printed Name of Signe Jfrfr MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Rep I nd 21037126 Record ing on behalf of Mason County Pu6W (/ CRICHARD I.bAZZEi.L Health),/ riy LICENSEDDFSIGNER 7/ / Signor roof Environmental Heafth Specialist Date '" A',-, (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ° '° I'2 '� LEGEND CALIBER RECORD OF CONSTRUCTION-AS-BUILT ___—PROPERTYLINE SEPTIC DESIGN Faaalblllty-New Construction-Rap&r + PROPERn CORNER 165 Tupleo Way Poulsbo,WA 98370 t-380.509.7900 I � ON-SITE SEPTIC SYSTEM COMPONENTS ROCKERY WALL I Pretreatment Tanks Aerobic Treatment Tank-Hagerman Precast Nuwater BNR500 '\ ASSUMED WATER MAI Pump Tank-Hagerman Precast 1250 gaVttomp(24geMn) PROFEsagN4L S1A1R Pump OVERHEAD POWER LIE \ N. Orenco PF5005 High Head Effluent,50 gpm.1l2"hp ASSUMED WATER LIN I \ AEROBIC TREATMENT TANK Tank Drawdown(inrminl:1" 100.00 GallonslMin-24 LINED WATER UMP TANK Gallons/Dase-24 FEATURE(6'X5) Doses/Day-10 r �•� l SLEEVED WATERLINE SetupDaiyFlow-240gaVday � J WALKWAY •:. ,j,—CONTROL PANEL Control Panel ItO37t28 ROCKERY WALL MAINTENANCE AIR PUMP OFFTe-ImimptezcomboParel ucf ot>Fs a ON Time-1 minute l OFF Time-24 hours PORTS p _ / i. INches Between on Float B Alann:l l" a IFW STAVE EXISTINGTWO% Cycle Counter Reading:000010 r, BEDROOM c Hour Meter Reading:28 w I i i$ SINGLE FAMILY :{ lug z _ Y r r Dispersal Component�� l w RESIDENCE pe •�'. -',: Site Constructed Gravel and Pi O I I o �� EXISTING Nutomr of Music5 1 .AI % I Constructed Wath(Bed1:107(24' I OFFICE I l z I —T— DECK '1 --•' ` !'CARPORT . Di V ibution Manaolo:Wwritlge LPD Headworks l De th Into Native Soil:36" ;,4 C, WITH FULL Vertical Separation:12" J•,'.: ggTH - I Size of orifices 1/B" I Number of Orfices:40 BED(240 SQ.FT) j RESERVE DRAINFIELD / / Tested titer Squi a Hegnt:>5' OBSERVATION PORT i 11'X42'(420 SQ.FT.) % °a MANIFOLD I SPECIAL CONSIDERATIONS SEWAGE DRNEWAY 100.00 1.Although water and sewage transport lines have been sleeved TRANSPORT I "ice::: :. within 40'of the sewage tanks,fubrre approvals by Mason County I'•.. -. - Pudic Health may require water and/or sewer lines to be relocated to Project LINE meinteinal0'sebeck. 31 NE WAGON WHEEL RD 2.Ventilation hr the aerobic treatment unit has been modified to BELFAIR,WA 98528 prevent nuisance odors.The ventilated riser lid has been replaced Awith a weterlair tight lid,and piping has been installed from the units Parcel#222025402011 PP digester chamber to the building st bout(cteanoutl. ®®®® k]8' 3.Due to the trash trap volume in the aerobic treasrem unit fffet]]]"' careened frequency of pumping may be required and is dependent Date: June 11,2026 on household occupancy,water usage.and other factors. JULSheet Name Li 2 2026 Record of Construction- Site Plan MASON COUNTY ENVIRONMENTAL HEALTH I� Sheet Number 1 SITE PLAN _'14 S D-1 •Zoo- o m a so PAGE 1 OF 1 Kayla Milam From: DO NOT REPLY <noreply@masoncountywa, Sent: ov>9 Tuesday, May 12, 2026 10:28 PM To: Environmentalhealth Subject: OSS Inspection request for Caliber Septic Design/Sandra Fredriksen - SWG2026-00100 Submittal request for: Caliber Septic Design/Sandra Fredriksen Site Address:31 NE Wagon Wheel Rd Permit Number:SWG2026-00100 VIL MAY 3 2026Parcel Number: 222025402011Installer Name: Korbyn Hurley 1 Installer Phone Number: 3602659062 By Installer Email Address: billing@qualitysepticinspection.com Designer Name: Richard Bazzell Designer Email Address: calibersepticdesign@gmail.com Inspection Request Date: 2026-05-12 Inspection Type: Full System Comment\ Notes: 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 must be submitted for final installation approval, b '%ice, •_'4 5 r 3z • . MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2026-00100 ADDRESS: 31 NE Wagon Wheel PARCEL: 222025402011 DATE: 5/14/2026 _ '�`'�... : . .-�\.. . �� '. •-�:�.�_. :mow._ �:......`'.'t+�. HOUSE TO DRAINFIELD ;.w 5fi.. i e DRAINFIELD TO HOUSE