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Home My WebLink AboutSWG2025-00379 - SWG As-Built - 9/11/2026 (2) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025 00379 Parcel# 222093400200 Applicant Name Harborstone Consulting Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 286 City, State, Zip Gig Harbor, WA 98335 Installer Name Josh Peterson Site Address 7120 NE Northshore Rd Belfair, W/ Designer Name Mike Jerkovich INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only 0 Grainfield Only ❑Repair ❑Other System Type Pressure Bed Pretreatment Type Nuwater BNR500 >5ft, fromfoundation? - - - - - - - - - -- - -- - - - - - - - - - - - -- ❑ N/A ®YES NO >50 ft.from wells? - - - - -- - - - ❑ ® ❑ Z >50 ft from surface water? - -- -'I a4. � ,� j� B _- ❑ ® ❑ h Cleanout between building and tank? 1 N>i - - - ❑ S ❑ tJ Tank baffles present? - - - - - - - - -L-';:;_ - _ LQ2u26 _ - ❑ ® ❑ 24"access risers over each compartm nt?- - - _ ❑ 5 ❑ NEffluent fiilter installed?- - - - - - - _ _CL9___ _ __ __ _ .- ® ❑ ❑ Septic tank capacity(working) 1000 gal Manufacturer Hagerman NuWater BNR500 JD-box water level and speed levelers used? - - - - - - - - -- -- - - - e NIA ❑YES ❑ NO OR Manifold/D-box accessible from surface?- - - - - - - - - -- - - - - - - ❑ ® ❑ O Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - -- ® ❑ ❑ f Transport Line Size 1.5 Schedule/Class Sch 40 Bedrooms installed (check one) III 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - -- ❑ NIA . YES NO >100ft.fromwells?- __ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _- ❑ ® ❑ W >100ft.fromsurfacewater? - - -- -- -- - - -- - - - - -- - - - - - - ❑ S ❑ LL >10ft.from potable wafer lines?- -- - - - - - - - - - - - - -- -- - - - ❑ ❑ Qz > 5ft. from property lines and easements?- - - - - - - - - - - - - - -- ❑ ® D > 30 ft.from downgradient curtain/foundation drains?- - - - - - - - - - 0 ® 0 Drainfield level and observation ports present - - - - - - - --- - - - - C] Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfeld?- - - - - -- - - - - - - - - - - -- ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- - -- -- --- -- - ❑ N/A ® YES ❑ NO Pump tank capacity(flood) 1000 gal Manufacturer Hagerman 24-access riser(s)and accessible from surface?- - - -- -- - - - - -- ❑ ® ❑ Alarm or Control Panel Installed? - - - -- - -- - - - - -- -- -- - - - C 5 ❑ Control Panel equipped with Timer I ETM/Counter - - - - - - - - - - ❑ 0 ❑ 0- Pump installed in S Bucket or ❑ On Block or ❑ Other Pump Make/Model Liberty L290 ■ Floats or ❑ Transducer a Tank draw down 2— in/mm Pump capacity __ gpm Squirt Height / Z ft Pump on time if, Pump off time 3 Daily flow set at Z'O gpd uoa.me arz'W. Mason County OSS Installation Report pg. 2 Parcel# 222093400200 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - -- -- - --- 0 NO If yes, please describe: 22e e0 , , tsA3 .J c G Were all components pumped out and properly abandoned per WAC246-272A-0300? --`- - - - - -- QJ^rES 0 NO RECORD DRAWING This la a pannm.nt record and must p.accu•M and Wacnpflw enough to re-locate in the n..d or mslna,unw acnrrcka and future development T Drawings mnlain: Dnod. d 8 nanibW orbnbtlpn 61eyout.Septic/pump Typical Record wala,observation ports tlenoula and pOalmaintandnceeccess Wmp link lncatlon.North snow,rororve dente ad.existing and proposed huikltion location of wolls,ed permits points. Incomp'ale Remrd onnvinas may create oddi6onal delays in finalins1.1aln approval and related permits. ❑ 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 clears d/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. Sig ureo/Installer Date Printed Name of Signae o~' MASON COUNTY PUBLIC HEALTH = N, The undersigned approves this Installation Report and - 5100365 Record Drawing on behalf of Mason County Public . MICHAEL D.JERKOYN:H Health: (III C Ir//��j� _•LCENSED DESIGNFii Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated a21Qota , . sit.Nun. L.uoo:7120 NE NORTH SHORE RD Service Company: p Y Belfair Tax ID: 222093400200 KITSAP SEPTIC PUMPING 5201 E.Hillcrest Or. Port Orchard,WA 98366 360.871.5258 Serviced:11119/2025 by: Ross Miller Submitted 12/17/2025 by:Darren Miller Dump cwxp.:Bio_Recyding Jurisdiction ID:222093400200 COMMENTS Pumpetl for relief.New system in progress. Tank Pumped: YES Total Gallons pumped from tank Number only,no text): 1000 Tank Size(Gallons)(Number only,no text): 1000 Tank depth below grade(inches): 12 Effluent level within operational limits(d NO explain In comments): NO wticienl Effluent returning back into tank after pum ng: NO Access Risers Installed to grade N/A If not present): N/A Tank Construction Material: Concrete Tank Condition Good: YES Baffles in good condition WA If not present): YES Effluent screen cleaned(WA if not present): WA Effluent surfacing around site components(N/A if not checked): NO Tank abandoned after pumping: NO Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment I Scum accumulation(Inches,if other specify): 0 Compartment I Sludge accumulation Inches,if other a 2 Thv nY.dcaso mSnd.,I c Of SN ywe 4nNse.am N U me w n.R.In m M"h MYnpyr.auv,I-oe , 4b,wNMnm,✓r Repor6D:853228 View pump repods online al www.onllnenne.mm Page 1 of 1 Ka rla Milani F Sent. DO NOT REPLY cnorepIyrnason countywa.govr To, Tuesday,August 4.20261:38 Pµ Subject; Environmentalhealth OSS Inspection request for Kattrax-SWG2025.00379 Submittal request for: Kattrax Site Address:7120 NE Northshore Rd Belfair,WA 98528 Permit Number:SWG2025-00379 Parcel Number:222093400200 Installer Name:JOSH PETERSON Installer Phone Number:2532556799 Installer Email Address:KATTRAX@CENTURYTEL.NET a AUGp4.Z�?6v� 6y Designer Name:Mike Jerkovich Designer Email Address:mjerkovich@harborstonellc.com Inspection Request Date:2026-08-04 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. MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2025-00379 ADDRESS: 7120 NE Northshore Rd PARCEL: 222093400200 DATE: 8/4/2026 I HOUSE TO DRAINFIELD & ø cSji DRAINFIELD TO HOUSE cn ti m ;°so ss - zLLz t oo'Qp _ 22 63 r A -- A z N.. N m � ; z i p A Cl / N T \; — n n D v v � , z O Z I � � V - 111TTT ti m v A A � D � mc o o Sp m O III z F 'UN�CIm I m 'ii C `L % °4 III Illm � n C� �I�" z T z N m m z o o N N O Z� v CO � s i V1 OZ ' O 7 p O w \ I a\s� ITJ C _ o C) n ' o o n e N O none P' a m o m �\ASm=om Cegn G rn msjig Ao$ 1 YH P iD s a� NOREEN UPTON � s : . . �; o g 7120 NE NORTH SHORE RD, BELFAIR, WA 98528 p Q PARCEL 22209-34-00200