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HomeMy WebLinkAboutSWG2025-00379 - SWG As-Built - 9/11/2026 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,WI Designer Name Mike Jerkovich INSTALLATION CHECKLIST ■ Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pressure Bed Pretreatment Type Nuwater BNR500 >5 ft.from foundation? - - - - - - - --- -- -- - - - - - - - - - -- -- ❑ N/A YES NO >50 ft.from wells? - - - -- - - -- ---- - - -- --- y? -t _ _ . ❑ ® ❑ >50 ft.from surface wate R - - - - - - �-i Ip FCleanout between building and tank? r, -- - - ❑ ® ❑ p „� P_1a16_ j SE02 ❑ ■ ❑ Tank baffles resents -. . - - - - - - 24"access risers over each compartm nt?-- -�. — _ ❑ ® ❑ W Effluent flter installedv- _ - - - - -- -L -- 7.{�y Septic tank capacity(working) 1000 gal Manufacturer Hagerman NuWater BNR500 D-box water level and speed levelers used? - - - - - -- - - - _ _ _ _ - ■ N/A ❑YES ❑ NO 00 Manifold/D-box accessible from surface?-- - - - - - - - -- -- - - - - ❑ ■ ❑ mz Check valves installed? - _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _- ■ ❑ ❑ G¢ S: Transport Line Size 1.5 Schedule/Class Sch 40 Bedrooms installed(check one) © 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?- - - - - - - - - - - - - - - - - - -- - - - - -- ❑ NIA YES NO G >100ft.fromwells?- ___ _ _ _____ __ __ _ _ _ _ _ _ __ _ _ _ _ _- ❑ ■ ❑ W >100ft.fromsurfacewater? - - - -- -- - - - -- - - - - - - - - - - - - ❑ ■ ❑ M >10ft.frompotablewaterlines?-- - - -- - - - - -- - - -- - -- - - - ❑ ■ 0 > 5ft.from property lines and easements?- - - - - - - - - - - - - - -- ❑ ■ ❑ > 30 ft.from downgradient curtain/foundation drains? - - - -- - - - - - 0 ® ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - 0 ■ Cl ❑ Graveless chambers or ■ Clean gravel used? (check one) Proper cover installed overdrainfield?- - - - -- -- - - - - - - - - - -- ❑ ® 0 Pump tank setbacks consistent with septic tank?-- - -- ----- - - - 0 N/A ■ YES ❑ NO ZY Pump tank capacity(flood) 1000 gal Manufacturer Hagerman 24 access riser(s)and accessible from surface?-- - - - - - - - - - -- ❑ ■ ❑ d Alarm or Control Panel Installed? - - -- - - - -- - - - - - -- - - - - - ❑ 0 ❑ Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - 0 ❑ - Pump installed in ■ Bucket or ❑ On Block or ❑ Other a Pump Make/Model Liberty L290 ■ Floats or� e ❑ Transducer y Tank draw down �" Z in/min Pump capacity? _gpm Squirt Height / Z ft Pump on time /Sec Pump off time 3 Daily flow set at 2`/O apd updated 8)212018 Mason County OSS Installation Report pg. 2 Parcel# 222093400200 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - -- - - -- NO If yes, please describe: /2e Cvawrs;lSica.-arf� •s,4�( i "kt Were all components pumped out and property abandoned per WAC246-272A-0300? - - - - - - -- Q-YES O NO RECORD DRAWING This Ica pennan.m nw,d-W must be.aunt.and Mecnptly.gwugh to r. ec.r.In th.need of maintenance adnrcx.and Mur.development Drawings contain DrelnfiSd&menilda orent, on d layout soptlU p rrWwa Record Wu Wm tank mp.te ,North Draw,reservemay dente ad,egding and proposes puikition aprelion o/wells,waterlines, wens.observation pads,aearoub end puler maintenance aase pads. inmmaare Record Drawings create edelamal delays m final imladmad D ppmvd and reieted 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 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. Sig , um of installer Date Printed Name of Signee _ ge MASON COUNTY PUBLIC HEALTH 447' - The undersigned approves this Installation Report and 5100365 Record Drawing on behalf of Mason County Public MICHAEL D.JERKOYICH. Health: 1I���JJJ/ DCENSFA DESIGNER r l,/erl III , - s.1426 Signature of Environmental Health th Specialist I l bate (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updd.d e/2enme Sit.IM.: 1c.Uou:7120 NE NORTH SHORE RD Service Company: Selralr Tax ID:222093400200 KITSAP SEPTIC PUMPING Un: 5201 E.Hilicrest Or. Port Orchard,WA98366 360.871.5258 Servicad:11/19/2025 by: Ross Miller Submitted 1211712025 by:Darren Miller Dump Loot°,,:BldRecycling Jurisdiction ID:222093400200 COMMENTS Pumped for relief.New system In progress. 7ad Pumped: _ YES ns pumped from tank Number only,no text): 1000 (Gallons)(Number only,no text): 1000 h below grade inches: 12 Effluentvel within operational lirnts(it NO explain in comments): NO Deficient turning back into tank after pumping: NO sers instaAed to grade N/A If not present): NIA Tank Cansimclion Material: Caxrete Tank Condition Good: YES Baffles in good condition N/A If not present): YES Effluent screen leaned(WAY not present): N/A Effluent sudadng around she components(N/A i/not checked): NO Tank abandoned after pumping: NO Were repairs made to the Tank or Tank Components?(l IVES explain in comment): NO Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Slue accumulation Inches,if other specify); 2 OS mon+ isc. ,rn.. .wr.of w o r .w.r .n uw bin!ww.m,w..ya im wr.wino,..w°,,nw,orpaan.m++ii.nc.. ReportiD:553225 VSwpump reywfs onNne et www.anllnemw.com Page 1 of 1 Ka la Milam 'Too Sot:' DO NOT REPLY ore Sent: m ceumywo,gov> Tuesday,August 4,2026 38 PM To: Environmentalhealth Subject; OSS Inspection request for Kattrax-P 9 SWG2025-00379 Submittal request for:Kattrax Site Address:7120 NE Northshore Rd Belfair,WA 98528 Permit Number:SWG2025-00379 Paicel Number:222093400200 Installer Name:JOSH PETERSON Installer Phone Number:2532556799FIRAIZE! Installer Email Address: KATTRAX@CENTURYTEL.NET 026�,iJ 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. 1 MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2025-00379 ADDRESS: 7120 NE Northshore Rd PARCEL: 222093400200 DATE: 8/4/2026 5w. HOUSE TO DRAINFIELD flr1� m DRAINFIELD TO HOUSE 1 _ _ ZLYZ ld mN0P- N4'03'44" 5 M.£C.9£_0N oti. _ 22.63' ,Sl'6Z Z \1 o i N I 1 m I Iy QV INS F S O N m � m ti 1S IW me n� \ I 0 s� A 00 j NNE m r / T V 0 A r 0 V N q_ tiZ \ m O m � n I:= m r O8 _ - \----------- n,a \ r-- Ni Ni O yaP \ - O ol03 O PP \ JIo O Ni m O O c ^ \ j v , so\m \ j C o 1 :; o !1!III!liI O o B N gym p (31 Yz' r7`' yz' r�' 36995 N '9mA^ynam PEA q r!b ( I F Yl' oil NOREEN UPTON & a 7120 NE NORTH SHORE RD, BELFAIR, WA 98528 + eg PARCEL 22209-34-00200