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Home My WebLink AboutSWG2019-00075 - SWG As-Built - 8/11/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2019-00075 Parcel # 12330-50-00073 Applicant Name R J Peabody Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 565 Beards Cove Div 3 Lot 73 City, State, Zip Burley, WA 98322 Installer Name Site Address 181 NE Anchor Dr; Belfair Designer Name Tom Weaver INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair El Other System Type Oscar II Pretreatment Type NuWater BNR 500 >5 ft. from foundation? - - - - - - - - - - - - -- -- - - - - - - - - - - - ❑ NIA •YES LINO >50 ft. from wells? ❑ ❑ Z >50 ft. from surface water? - - - ❑ S ❑ Cleanout between building and tank? - -- - ❑ ❑ Tank baffles present? - - - - - - - - - - - - - - ❑ U ❑ a24" access risers over each compartment?- -- -- -- - -- - - -- - El ❑ WEffluent filter installed?- - - - - - - - - -- - - - - - - - - - - - - - - - - El U El Septic tank capacity (working) 1250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - 0 N/A ❑YES ❑ NO �O Manifold/D-box accessible from surface? S ❑ ❑ cc z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - 5 ❑ ❑ OQ f Transport Line Size P' Schedule/Class Sch 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - -- - - - - - - - - - - - ❑ NIA • YES ❑ NO >100 ft. from wells?- - - - - - - - - - -- - - - - - - - - - -- - - - - - - ❑ ❑ W >100 ft. from surface water? ❑ ❑ E >10ft. from potable water lines?- - - -- - - - - - El ❑ ? > 5 ft. from property lines and easements?- - - -- - - - - - - - - - - ❑ ❑ > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - El El Drainfield level and observation ports present - - - - - - - - - - - - -- - - - - E El ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed overdrainfield?- -- - -- - - - - - - - - - - - - - ❑ ❑ Pump tank setbacks consistent with septic tank?- -- - - - - -- - -- - ❑ N/A YES ❑ NO Pump tank capacity (flood) 1250 gal Manufacturer Hagerman Q24" access riser(s)and accessible from surface?- - - - - -- - - - - - -- - - - ❑ El ~ Alarm or Control Panel Installed? ❑ ® ❑ 2 Control Panel equipped with Timer I ETM/Counter - - - - - - - - - ❑ U 0 fl Pump installed in ❑ Bucket or ❑ On Block or • Other As required for proprietary device 1 Pump Make/Model 4Y mcDonald /AY 1/2hp U Floats or ❑ Transducer a Tank draw down 15 in/min Pump capacity 2.5 gpm Squirt Height NA ft Pump on time 22 SEC Pump off time 3 Min 38 Sec Daily flow set at 360 god ugeaarzirzae Mason County OSS Installation Report pg. 2 Parcel# 12330-50-00073 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 WAC24S-272A-0300? - ❑ YES NO RECORD DRAWING Th s Is• permanent nmrn•M must M•rcural and ae•cnpllw enough to re-locate In as,need of msmmn•nea•ctlrleea and lutist development Typical Rewrd Dcn gs conlan: Drainfield&manifold memradn&kyou,Se$if/pump tank bcaton,Norm anon,rSOVW haMhd,seising and proposed bumps, mWicn d x214,vMerinaa, wells,obsM/Yi0n pons,cknWls,&d other maintenance aVeSS pon4. IncomplNe Record DrvNq•may nede addFt naI delays M(n n l sl•Itcn pprca and d mMPo p n11hs. S-rc'f ""'' CO°4 i/ Tee osbu Ir lr Zo2 ' ©3St PacSrb bY\ Record Drawing Attached CERTIFICATION OF INSTALLATION 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 Record Drawing is accurate, form and attached Record Drawing is accurate. ( f ,/- _------__ I 8/11/2026 Signature`-of Installer Date JASON SCHAUER ThshI lh t�7Pl�� Printed Name of Signee fr9Y MASON COUNTY PUBLIC HEALTH t '!�^ The undersigned approves this Installation Report and 1. Record Drawing on behalf of Mason County Public Health: can usFnpEfi-mss , 911i124 12 k o�i jl c Signature of Environmental Health Specialist Dale (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 'led emndle SL# 1 0" - 32" Brown Silt Loam 32" Mottled Silt Loam SL# 2 0" - 32" Brown Silt Loam 32" Mottled Silt Loam SL# 3 0" - 32" Brown Silt Loam N 32" Mottled Silt Loam +18' el k5 NFgn r�4 chorbr 8 6 k' 1amin 1 s 0m° +8'el O) r.4 Nu A Vie' 0 h �V 3 Bedroom 100' From Roadside Ditch 4 0 Building 0 _ ° 0 r D" Envelope "mr7 y J ~ I. xa W 8 a O� 0 P to H a xQ,e 2 +6' el sroosu' NSE TNOSSE E.wFN.i11 C tGEM - APPPOVE�° AUG ' 1 2676 _________ - g/ / N 4r Allied Design,Inc Scale = I" = 20' Address: "' NE Anchor Dr, Belfeir Name: Peabody " On-Site Septic Design " Lot 73 Beards Cove #3 Tax parcel # 12330-50-O0073 This is not a survey;ell property lines/ba..daries have been demonstrated by the Ov er(amid/or their Agent(s).