The URL can be used to link to this page

Home My WebLink AboutSWG2026-00254 - SWG As-Built - 9/15/2026 Masil County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWGZWZ&-apt5`/ Parcel it_____________________________ Applicant Name (tA4*0ii SdHj) LE& Subdivision(Name/Div/BIocWLot) Applicant Address Z_ AX AnAtttAL DQ City, State,Zip BEL.FALE WA 9PS2f Installer Name k.2TSQ Site Address 2_ AS- ADMILAL D2.- Designer Name D41/E &SIYLZIW INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only J0 Grainfield Only O Repair ❑Other System Type A'LAUSTY Pretreatment Type >5 ft.from foundation? ---------- R Wa F ONO >50 ft.from wells? ❑ z >50 ft.from surface wateR --------Ii- Cleanout F between building and tank? -- -'S�-Q B_�6_ ) O ❑ ❑ V Tankbafflespresent? ---------- ---- O a 24"access risers over each comparenen �--.--- ❑ ❑ W Effluent filter installed?------------------ -------- ❑ [ ❑ h Septic tank capacity(working) tti5Q gal Manufacturer 0 D-box water level and speedlevelers used? --------------- ❑WA s ❑ NO QLI- O ManifoldtD-box accessible from surface?----------------- ❑ - ❑ m.2 Check valves installed? --------------------------- NY' --�--------------------• 1FW-, ❑ ❑ O1 Transport Line Size 4, Schedule/Class t O Bedrooms installed(check one) 0 513 04 ❑5 ❑6 ❑Commercial/Other >10 ft from foundation?--------------------------- ❑NIA s ❑ No 13 '1100 ft.from wells?-___________________________- ❑ ❑ W >100Rfrom surface water?-__________________ ___- ❑ O it >to6_fmmpotabiewatw linss?.--------------------- ❑ I2 ❑ a >5ft.from propertylines andeasements?-______________ _ ❑ �/ ❑ >30 ft.from downgradient curtain/foundation drain?---------- O ❑ Drainfield level and observationporjs present ------ -------- O ❑ O Graveless chambers or WClean gravel used? (check one) Proper cover installed over drainfield?------------------ ------------------- - Pumptank setbacks consistent with septic tank?------------- WA ❑ vEs O N Pump tank capacity(flood) cal Manufacturer Q24'accessriser(s)and accessible fmmsurface?------------ - ❑ ❑ ❑ . Alarm or Control Panel Installed? --------------------- ❑ ❑ O 2 Control Panel equipped with Timer I ETM/Courtier----------- ❑ O ❑ IL Pump installed in O Bucket or O On Block or O OIMr 6 Pump MakefModel ❑Floats or O Transducer 0. Tank draw down iNmin Pump capacity Opm Squirt Height ft Pump on time Pump oftime Daly flow set at gpd uw+.+axraure Mason County OSS Installation Report pg. 2 Parcel II ABANDONMENT RECORD Were existing septic components abandoned ap part of this project? -- ---- ------- - - - YES F NO If yes, please describe: w f7rotnF V Were all components pumped out and properly abandoned per WAC248-272A-0300? ------ - - YES ❑ NO RECORD DRAWING Oils :.wrrmn.m record and mart ba accurate and descriptive enunyn to re-locate m me nwa or mainunance activities and Future development. Typ'el Record DraMre sntam'. Drameeld a mmio(orlemln a layout.SepddW cop lank location.NOM arrow,resolve eramrnrd,exunag aria proposed W Iw,ngs,mraoon Noels,waredines. walla observation poste.deanoils,and other manrenance.Ueae point. Incomplete Remra Drawings may eere addiaul delays m anal msrallabon approval and seated permits. SS i�9Taie � Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER)ENGINEER I certify that!installed the system in accordance with I certify that the system has been installed In actor- the septic design stamped'APPROVED"byMason 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 clearedlapproved by both the designer shown hem have been ciearedfapproved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all and Mason County Codes. Slate and Mason County Codes 1 further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. tam and attached Record Drawing is accurate. ituWV p�G4 t�— gnafura of Installer Date DAVLZE.t) MYLGER Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and •?a.. Record Drawing on behalf of Mason County Public b1 R .. Hea 9 _,f.. / lJ V f e:r-.t.siaAlll SIgIuse of Environmental Health Specialist Date (stamp,signature and date) THIS FORM MAYBE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE M`°a°W21a°nfi Recess➢ of Construction ®rowBny Note:This Is a permanent record. Please use a straightedge to prepare an accurate,detailed drawing of the item.that are associated to the new septic/pump tank or curtain drain Installation that OQn yr affects the 035 system,drawn to scale OR locations triangulated,that Inoludes the following required Information: o Show the lotatlun of all septic)pump tank lids and distribution boxes etc. o if installing a curtain drain show its dean-outs and distances to axlsling osS dispersal syetem(8). o Show as show all surface water sources,wells, buildings,water lines, Curtin drains,roof infiftralon systems,etc. and their distances to the 066, J, N• l —toI -1 Appj � Sfp ® .s"° . 57076 RASONOOON ryEOJlq NMEV 4 H£A(TH a ,onw i. 'a a °. air I x N 9 3 ? m ? `'-0 m O S �1 g 'n _ . u " =or •Asa xy3S n � ❑ m m � 8S N _u pnp s m y o 0 w 3a88 R 3 ' $ 3 - . � sa s op aag 8 ❑ a =s°a: ° ❑ S ❑ ❑❑ ❑� ❑ m = y 90 ❑ m FS S 3 3 0 « m g x y s a sm x v ❑ ❑❑ ❑ ❑� r fl 211� g < zizz ❑ o ❑ ❑ ❑ ❑❑ m 9y O ` ! S a 0 0 0 9 m - < z z o x m _ 'O '.W € ' O zz z_ z_ m o m : 3 ❑ ❑ . c p -] D ° D > i m zzm ❑ o v N Amao A n D T w ® 2 m ❑ p 4• S _ o,m t9 m Y m n 3 ❑❑ i m 0^�6 m n 3p ff . 33 s o ❑ 1 ❑ �r� 8 e ° O m m n E3 ❑ m < N 3 o - 3 Nw m �G � c vo �Dm 00010 " o b r X r W . Ii%!4i1iLV1iW 1 • 11 _.cy � • • " roRC Sepoem�o,aa,zaz@�L33 D • • ..a d Ka DO NOT REPLY <noreply@masoncounagov Monday,August 31, 2026 7:56 AM Environmental health ��II O55 Inspection request for John Lew Crawford &Meagan C Crawford- SWG2026-00254 :Submittal request for:John Lew Crawford& Meagan C Crawford Site Address:21 NE Admiral Dr Belfair Wa 98528 •fl Permit Number:SWG2026-00254 Parcel Number: 123305400002 Installer Name: Kitsap Septic Pumping INC Installer Phone Number:3608715258 i!! Installer Email Address:office@kitsapseptic.net fYf1 Designer Name: Daves Septic Design _ IYy Designer Email Address: dave@dss9699.com - --- ' t, spection Request Date: 2026-09-01 spection Type: Full System mment\Notes: ank you for submitting your final install request.The install should be complete and ready to inspect on the 'Inspectio -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 assdisiltMinriInal installation approval. -� ., 4: