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HomeMy WebLinkAboutSWG2025-00419/ASBUILT - SWG As-Built - 9/4/2026 0 "M MaIolr ..ounty OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG - 2025-00419 Parcel# 123204390090 Applicant Name Cathy arms QSa v t Subdivision (Name/Div/Block/Lot) Applicant Address 641 NE OLD BELFAIR HWY TR 9 OF SW SE PCLAOF SP#256 AF#319272 City, State, Zip BELFAIR,WA98528 Installer Name Eric Gregory Site Address 641 NE OLD SELFAIR HWY Designer Name Jim Zimny INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfteld Only 0 Repair ❑Other System Type Gravity Distribution Pretreatment Type >5 ft. from foundation? -- -- ❑ NIA YES 0 N _ _ - >50 ft. from wells? --- --- - ❑ ® ❑ Z >50 ft.from surface water? - - AUG 2 6 Lu26 � y. ❑ ■ ❑ FQ- Cleanout between building and 0 ----- ----- - Tank baflespresent? - - - ------- n ❑ • ❑ d24"access risers over each m me - - -- ❑ U ❑ W Effluent filter installed?- - - -- --- --------- ---- - -- --- ❑ 5 ❑ N Septic tank capacity(working) 1250 gal Manufacturer Hagemlan o D-box water level and speedlevelers used? - - - ------- --- -- ❑ N/A 5YES NO J ❑ ❑Manifold/O.box accessible from surface?--- -- --- - --- --- - - mz Check valves installed? --- - -- --- - - ----- - - - ---- - - - — ❑ ❑ O4 Transport Line Size 4" Schedule/Class 3034 f Bedrooms installed (check one) ❑ 2 ©3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?---- - - - -- -- - - - ----- - - ----- ❑ N/A • YES ❑ N0 >100 ft. from wells?-_ _ _ ___ __ __ _ __ _ _________ __ _ _ - ❑ ® ❑ W >100ft. fromsurfacewater? --- -- -- ------------ -- - ❑ e ❑ E >10ft. from potable water lines?------- - ----- -- ------- 5ft. from property lines and easements?---- - - -------- - - ❑ ❑ > 30 ft.from downgradient curtain/foundation drains?- - - - - - -- - - 0 ® ❑ o Drainfied level and observation ports present ----- - --- -- - - 0 ® ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Propercover installed overdrainfield?-- ---- --- -- -- - --- - - ❑ ® ❑ Pump tank setbacks consistent with septic tank?------------- 5 N/A 0 0 N Y Pump tank capacity(flood) oat Manufacturer Q24"access riser(s)and accessible from surface?----------- - - ❑ ❑ ❑ aAlarm or Control Panel Installed? -- ----- -- --- --- --- --- ❑ ❑ ❑ 2 Control Panel equipped with Timer/ETM/Counter-- - - - - - ---- ❑ ❑ ❑ M d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump Make/Model 0 Floats or 0 Transducer 2 a Tank draw down in/min Pump capacity dpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Upd.1 &21/2C16 Mason County OSS Installation Report pg. 2 ParcelY (z3tO�l�`100 QO ABANDONMENT RECORD were exRpng septic components aha,coneC as :x' I's roje0! ------ YES K NO ves please descr," _ _—. .. . _. 'l.'__ NO d4re a4 ccrtConenK Pum v ped �and P•co*T , _ . _ ...<5.a:- _ - __ __ -.-- -- - - - YES RECORD DRAWING fl,rc l .,t record aM dal Oe stei n4 sin Nw.rf,.e enmyn In..teat.a me tied N mingnlne M4Mf lM M1Nw Ss I r." a Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER i certify That?installed the system in accordance w,ffr cemy that the system has been installed in actor- The septic design stamped -APPROVED by Mason lance with the seprrc design Stamped'APPROVED by County Public Health and trial any deviations shmm' Mason County Pubic Heath and that any deviations here have been cleared/approved by both the desrnne: snow/heave have been cleared/approved by both and Mason County Pubic Health and meet all State myself and Mason Courtly Public Heath and meet all and Mason County Codes Stare and Mason County Codes I further Gerry that all information contained or,Ites 1 rustier comfy that an mfomabon contanted on Nis form and attached RecordDrawing is accurate inrm and attached Record Orawings accurate Chr , Printed Name of Sign MASON COUNTY PUBLIC HEALTH P : The undersigned approves this Installation Report and Record pawing on behalf of Mason County Public $ o Li N i'In"Ea Heath ��.QmoW Signature I Envronm rm HUai^spocasv . !stamp signature and date? nas roRM MAYA SCAY: - - _ ... ... . .. � ~ hi �+c -: fl 55 a M ON3 Y m w o O1 166.4 ` �N I o m o0D v $ � O n o� mm m ^ ro ti O ^ Q D N m > Q d C Z • Z t`t o, l, gj Q .O : 0 C y0 ryyN 6 6 1 Z (_] V� I I oO SST - O u1 ryry ySe ly m H in LJ a. . : I N 1 N b Q 1 W m O Z N_ 107' Ala Milan, From: Sent: DO NOT REPLY <ooreply@masoncoun To: Wednesday,July 8, 2026 9:44 AM tywa.gov> Subject: Environmental health OSS Inspection request for Eric Gregory-5WG2025-00419 Submittal request for: Eric Gregory Site Address:641 NE Old Belfair HWY Belfair WA 98546 Permit Number:5WG2025-00419 Parcel Number: 123204390090 Installer Name: Phoenix Development Et2IG &IQlot2`( Installer Phone Number:3605099281 � n C� Installer Email Address:phxdevllc@gmail.com JUL 0 6 2026 2026 !J signer Name:Jim Zimney 6y signer Email Address: apddesigns@icloud.com lquest pection Request Date�d62:3�iQ"" ection Type: Full System ment\Notes: nk you for submitting your final install request. The install should be complete and ready to inspect on the 'Inspection Date'and remain uncovered for three business days to allow staff time to inspect. Poor weather situations may ccommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installation oyal prior to backfill of system components. If no contact Is made by the health department within the three ness days of notice, the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation fee must bmitted for final installation approval. 0 * (j4 MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2025-00419 ADDRESS: 641 NE Old Belfair Hwy PARCEL: 123204390090 DATE: 7/10/2026 1. Vt i II � HOUSE TO DRAINFIELD w i DRAINFIELD TO HOUSE