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HomeMy WebLinkAboutSWG2023-00399-ASBUILT - SWG As-Built - 6/15/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT!P=R* TION Permit Number SwG 2023-00399 05-21-90071Applicant Name Kdstopher&Terri Klusmaname/Div/Block/Lot)Applicant Address PO Box 2816city, State, Zip Belfair WA 98528e Owner InstallSite Address 450 NE Alder Creek Ln Belfaire Arrow Septic Designs Inc _ INSTALLATION CHECKLIST Fa�s ll System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑OtherGreyPretreatment TypSystem Type (�ryWAVEa ❑ NO fromtoundation? - - --- - - - - ❑ ❑ ftfrom wells? - - - - - ' - - - llLJi� ❑ft. from surface water? - - - - - - - - - - Onout between building end tank? _ JUN_ _ __ _baffles presem? . _ _ __ _ _ _ _ _ _ _ _access risers over each compartm ❑ent filter installed?- - - - - - - - - - - - - - - - - - gman tic tank capacity(working) 1 000 sal Manufacturerox water level and speed levelers used? - - - - - - - - - - - - - - - ❑ "rA YEs ❑ No - - - - - - --ifold/D-box accessible from surface?- - - - ❑ ® ❑- - - - ❑ ❑ckvalvesinslalled? - - - - - - - - - - - - - " - - - - - - - - - - - Transport Line Size 4' SchedulelClass 3034 Bedrooms installed(check one) ® 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑CommerciallOther >loft.fromfoundation?- [] NSA ® YES ONO >100 ft. from wells?__ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ OJ >looft,fromsurfacewater? - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . ❑ ® ❑ W LL >10ft.from potable water lines?- - - - --- - - - - - - - - - -- ❑ z > 5 fl. from property lines and easements?- - - - - - - - 0 >30 ft from downgradient curtainttoundation drains? - - - - - - - - - ❑ ® ❑ G ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) ❑ Proper cover installed over - -- O-- ❑ UI - - - - - - - - - -- - - - - tank setbacks consistent with septic lank?-- - - - - - - - - - - - ❑ WA 0 YES NO Y Pump tank ca flood) gal Manufacturer 6 24'access nxr(s)entl e ❑ - le from surface? ❑ - - - - - - - - - - - - ❑ ❑ 0 Alarm or Control Panel Installed? - - - _- a ❑ ❑ ❑ .'f Control Panel equipped with Tim - Tinier I ETM I Coun a Pump installed in ❑ Bucket or ock or ❑ LL Pump Make/Model ❑ Floa r 0 Transducer a Tank d iNmin Pump capacity qpm Squirt Height ft Pump off lime Daily flow set at mp on time ,,, „,wnx1n ' 12205 21-goo71 Mason County 0SS Installation Report pg. 2 Parcel YES NO Were existing septic mmPonants abandoned as part of this Prof? - __ _ If yes. Please descnbe: YES NO Were all components Dumped out and OroD�Y abandoned Dar WAC24&272A-030D? ' '-- - e n M+elePmml TV.Re and muff M YfYbb end aeeagptive enaaall to n-loa In the nMn N mYfl1*' Y.WN WiiM5.bf81i011 M Nb.WdbNnl6. OTt 'Drib b e P^aht Dr record• lank bllaaan.Nat maw,mpelve afHMq.evuiM end Pmpa� ,p rtb*E a s. DleWi9a Cnbm'. Dr BmWbq awMlQ'd leWYl3eVUWna >eale alOGgnil CebYenM0lnaa:leWn WMa'"e• wells.aaMneun N'b.fleeglnf'�0111ef MiNMYQ eLPee P]mb. Inmmp4le RaWa DIM'inGk mri 0 &r s\ckk 4x _ - - rr+6NT Record Drawing Attached _______________________ - I..- DESIGNER/ENGINEER INSTALLER I certify that!installed the system in accordance with /certify that dance with theese system design statamped 'APPROVED'by the septic design stamped#APPROVED"by Mason County Public Health and that any deviations shown Mason County Public Health and that any deviations hem have been dearad/approved by both the designer shown here have been cleared/aPPmved by both and Mason County Public Health and meet all State myself and Mason County Public State and Mason County Codes Health and meet ell and Mason County Codes. all infot7natiofl contained I further certify that all information contained on this IOC and attached certify tRecord Drawing is accurate.this form and attached Record Drawing is accurate. 3d ,AS Signature of Installer Date ths xt 1 SI a Z piloted Name of Signee xe MASON COUNTY PUBLIC HEALTH,. ` The undersigned approves this Instal n Re ) v-d 'F�uu�cr uoNNsov �''. Record Drawing on behalf of Mason CouFl/bii ?y<, /YYt'h�igo 171 75/ 2079/ %y -e4 (cw Zs Signs o1 Environmental He&N Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uaaoRa az+aa+e SCALD.:�"=40' V -(5¢¢l KLIISMkN . � nc., arc A� eFefptiEKW ad PAVIAJDY JCNN$GN�'�l 6-R, L5 at1^ 5gig�s jrookSt0 bo'�DM az lo.,9\s Hoots to �ttoM. I 4 glsw / �f roo'�5. , � �o � tors-rRu.G" �ati Nouse O e `— 4, E ACK sLge "•'. ; O XT a r.n J:•. b prm,r, VYmYCr 1. l u ' _ I s erg' 0 F(oM / e al 2d Y 2z wee 1 . dove iE- ° EicsEMEt-'T 30 © r'mo Ganoa Septic Tea1c �J�+ 2-Comply=eat with r'�lnenc 1 © D-Box with speed-levelers — — — — _ l —' end cover to surface APPROVED JUN 252025 MASON COUNTY ENVIRCNMTNTAL HEALTH 034