HomeMy WebLinkAboutSWG2022-00506 - SWG As-Built - 7/17/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG^ 21t Z-7 00 S�6 Parcel# ZZZ\Z5( a0
f�Applicant Name c Subdivision (Name/Div/Block/Lot)
Applicant Address \7801 ' . C*k \iot.*c
City, State, Zip bc.Vcy' Wit �D'5Z.8 Installer Name trNk \e fr+4t
Site Address S C1XYLR , Designer Name yr
1.� INSTALLATION CHECKLIST
W Full System Installation ❑Tank(s)Only ❑Dralnfield Only E Repair ❑Other
System Type d S "' Pretreatment Type t"
>5 fl. from foundation? - - --- - - - - --------- -- - - - - -- -
❑ N/A ®YES ❑ NO
>50 ft from wells? -___ _ __ _ _ _ _ _ ____ _ __ _ _ _ _ _ __ __ - ❑ ❑
2 >50ft. from surface water? . -- - -- - - - - - ---- - - - - -- - - - ❑ El
FCleanout between building and tank? --- -- - - - - -- -- -- -- -- ❑ i ❑
O Tank baffles present? -_ _ _ _ _ _ _ _ _ _ _ _ _ __ __ _ __ __ _ _ _ - ❑ IX' ❑
d24"access risers over each compartment?- --- - --- -- - - -- - - ❑ ❑
N Effluent filter Installleed7-- - - - - - - - - - - -- --- - --- - - - - -- Li ❑
121
Septic lank size SOD gal Manufacturer —Alo \an•�rf'
OJ D-box water level and speed levelers used? -- - --- ---- - - --- ® N/A fl YES 0 N
0O Manifold/D-box accessible from surface?- --- - - - --- - - -- - - - ❑ ® ❑
0°Z Check valves installed? - - - - - - ---- - - --- - - - - ❑ ❑
Transport Line Size �\v io P Schedule/Class
Bedrooms installed(check one) 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?-- -- - - - - - - - - - -- -- - - - - - -- - - ❑ N/A EYES Duo
o >100 ft.from wells?- - -- - - - - - --- - - - - - - _ - ❑ ❑
W >100ft.from surface water?- - - - - - - - - -- ------ - - - -- -- ❑ ❑
tT >10 ft. from potable water lines?- - - - - - - ---- ----- - - - - -- ❑ ❑
jj
> 5ft. from property lines and easements?--- - - - --- - - -- - - ❑ II ❑
> 30 ft. from downgradient curtain/foundation drains?-- -- - - - - - - ❑ ❑
Li
Dralnfield level and observation ports present - - - - -- ❑ ❑ Li
❑ Graveless chambers or ❑ Clean gravel used? (check one) N/A
Proper cover installed over drainfield?--- - -- - - - -- -- - - - - -- O ® ❑
Pump tank setbacks consistant with septic tank?- - ----- -- -c-- --- fl N/A [`[I YES ❑ NO
zPump tank size_________________gal Manufacturer \_c7r'n
Q 24"access riser(s) and accessible from surface?-- -- --- --- - - - ❑ Q ❑
Alarm or Control Panel Installed? - --- - - - - - - - - ❑ 14 ❑
Control Panel equipped with Timer I ETM/Counter- - - - - - - - - - - ❑ E ❑
Pump installed in ❑ Bucket or ® On Block lo or ❑ Other
Pump MakelModel a' 1�-<t�Jlw + \1 J V lZ Floats or ❑ Transducer
OSCAR
Tank draw down in/min Pump capacity fi Y 3O9Pm Squirt Height N/A ft
Pump on time OSCAR Pump off lime OSCAR Daily flow set at 240 gpd
Up$NBQIRo18
Mason County Oss Installation Report pg. 2 Parcel u
ABANDONMENT RECORD
Were existing sepfic components abandoned as part of this pro(ed"
If yes. pleasedescribe: / - - - - '- - - - � ® YES � NO
Were all components pumped out and property abandoned per WAC246-272A-0300? - - -
_ __ . ® YES NO fT RECORD DRAWING
thF s a nelm)nenl• co,d and niusl b e aecurn¢and Ut.eri011ve¢uouyM1 lo redo Uta.NnpY WPIp'n a n491J 6 rn 'rilo4 vicnra bn [ale it IM1n neeJ¢1 nv,e1.J [e agrrli¢[an J IUImP Jeveln
veils.JJs,, :J,PJPS cIartrvp nnPJlpetmanl¢napl[ee(mfp N At, IIRx IVlcnM1^ n0IS !J ¢ ,r PmaaL I*JMed;NevmP
Iren1Y. Ir¢„rn ryJ dten.Leo ¢ Yuny ann wpvJn pp lmny*.IJ:m.on pl,.,uva ,er r.eY IrIf Iv[nrJ UtarvrrJt n 3Y ureun a;In;;Jnal Jelaps In Lnap...... aan n;14t0val pmt IPIartd pout's
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❑ Record Drawing Attached
CERTIFICATION OFF INSTALLATION
INSTALLER
1 certify that I installed the system in accordance Wi/h DESIGNER/ENGINEER
the septic design stamped'APPROVEDr'by Mason 1 ante that the system has been installed in accor-
dance with the septic design stamped APPROVED by
County Pube Health and that any deviations sh Sp Mason County Public Heat/I,and that any deviations
here have been clearsd/.ipproved by both the designer shown here have n
and Mason County Public Health and meet all State myself and Mason County Pu // by
blicHeal h and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this l further certify that all information Contained On this
f - a attach tl Re or(l DrBpnilg is accurate, form and attached Record Drawing is accurate.
m1rng�n1a�rurc I411n5ta1llolr Onle
Pnrr(ed Mme of Slynee cl
MASON COUNTY PUBLIC HEALTH ¢�•
The undersigned approves this Installation Ropod and oys •,
Record Drawing on behalf of MASON County Public Mawr e M u dum•.
LICENSED DESIGNER
Health: '�'J
'\ th 1 ��� r , 7/16/2026Signature of Environment? Hea/tb Spnciatssl Dale
(stamp, signature and dole)
i1IIS FORM MAY BF SCANNED ANDAVAILARLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE rT'ra'•'rearaprs
site Na me.
Location. 17801 E STATE ROUTE 105 Service Company:
Belfair
Tax O: 222125400020 KITSAP SEPTIC PUMPING
5201 E.Hillcrest Dr.
Port Orchard,WA 98366
360 871 5258
Serviced:0 711 812 0 2 3 by:Trenton Miller Submitted 07/19/2023 by:Darren Miller
n.mp coo.oe.:Be-Recycling Jurisdiction ID:222125400020
COMMENTS
Pumped for demo
Tank Pumped. YES
Total Gallons pumped from tank(Number only,no text): 350
Tank Size(Gallons)(Number only, no text)'. 350
Tank depth below grade(inches): 0
Effluent level within operational limits(if NO explain in comments)- YES
Effluent returning back into tank after pumping. NO
Access Risers installed to grade(NIA if not present): YES
Tank Construction Material: Concrete
Tank Condition Good'. YES
Baffles in good condition(N/A if not present)'. YES
Effluent screen cleaned N/A if not present). N/A
Effluent surfacing around site components(N/A if not checked)'. NO
Tank abandoned after pumping: YES
Were repairs made to the Tank or Tank Components?(if YES explain in comments)'. NO
Compartment 1 Scum accumulation(Inches,if other specify) 3
Compartment 1 Sludge accumulation(Inches,if other specify)'. 3
Compartment 2 Scum accumulation(Inches,if other specify): 0
Compartment 2 Sludge accumulation(Inches,if other specify)'. 1
Repor00:888629 View pump reports omine at�wmvonlinerme.com Page f of t
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