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HomeMy WebLinkAboutSWG2020-00214 - SWG As-Built - 6/27/2022 • , Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2020-00214 Parcel# 222025200023 Applicant Name Dan Zuber Subdivision (Name/Div/Block/Lot) Applicant Address 19473 Cherry Blossom loop IN. City, State, Zip Pouisbo Wa.98370 Installer Name Shumaker Construction Site Address 4843 NE North Shore .. Designer Name Allied INSTALLATION CHECKLIST jim Full System Installation 0 Tank(s)Only 0 Grainfield Only ❑Repair ❑Other System Type_ pressure distribution Pretreatment Type >5 ft,from foundation? - -- -- - - -_ ©NIA ■YES 0 NO >50 ft,from wells? 111 0 Z >50 ft.from surface water? - - - - - - --- --- _ __ 0 II 14 Cleanout between building and tank? ✓ Tank baffles present? - 0 U 0 1--- 24"access risers over each compartment? ---- -- 0 N W Effluent fitter installed?- 0 II Septic tank capacity(working) 1000 gal Manufacturer Hagermen's precast Ca D-box water level and speed levelers used? - --- - ® N/A ❑ YES ❑ NO C3itlManifold/D-box accessible from surface?- - -- - 0 IN I?- Check valves installed? - ❑ 0 El 2 Transport Line Size 2" Schedule/Class sch 40 Bedrooms installed (check one) ® 2 0 3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- ❑ N/A II YES 0 NO O >100 ft.from wells?- - 0 ■ ❑ W >100 ft.from surface water? - - 0 II ta. >10 ft.from potable water lines?. - _ 0 II 0 Q >5 ft.from property lines and easements?- - 0 I Q Q > 30 ft.from downgradient curtain/foundation drains?- - 0 U 0 Drainfield level and observation ports present - - 0 N 0 Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?--- -- - --- Pump tank setbacks consistent with septic tank?- - 0 WA II YES 0 NO NGPump tank capacity(flood) 1200 gal Manufacturer Hagerrnen's 44- 24"access riser(s)and accessible from surface?- 16 tl. Alarm or Control Panel Installed? - - ❑ Q 0 2 Control Panel equipped with Timer/ETM/Counter- - 0 NI 0 II Pump installed in II Bucket or 0 On Block or ❑ Other ti.• Pump Make/Model liberty 280 Floats or ❑ Transducer E Tank draw down Z in/min Pumpcapacity a. p ty 6Y3 gpm Squirt Height 7 ft Pump on time 2.5 /-i4 Pump off time l A r Daily flow set at 09v gpd ,Updated A121+2018 Mason County OSS Installation Report py. 2 Parcel it 222025200023 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? • - — - [3 YES El NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - --- - - YES 0 NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to isr4ocatit in the need of maintenance activities and future deveicipment. Typcal Recxxd Dravnngs contain Drainfleid&,anifo+cf oi-ereacur, layoot,SerTipump WO,iocauon sk-11,anow reserve ctanfirid,el.- 3,11 proposed 2>toidngs locaton u!wets,watertries, wells.observation pQrts,Die and olhe,maintenance accebs points,. incomp#ete Reuel DraW41,35 creaZe adCri•Jo'ad(*laps w:trial qtstaftation apruval art reiateo peords. fp-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 ail and Mason County Codes. State and Mason County Codes I further certify that ail 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. Signature of Installer Date 444..1 -C4 4 6.44.4"--- Print Name of Signee „,ri • „""' MASON COUNTY PUBLIC HEALTH ' • -" „ The undersigned approves this installation Report and .40 , 4(312 33 4ft $ , .• rimr,e Record Drawing on behalf of Mason County Public Health: ,„„ LICE Et OEStCNEe sNN vb.% Expires:11/17/ Signature of Environmental 19ea11h Specialist Dote (stamp, signature and date) • THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE °P4a114 1°2'1'21t .... i 141:5 rthls h e rc Rd li . o It t n) 4. = . II II i I i I I I \ a\ A I\ 1 \ \ \ I I 0. .. \ ‘ • r,,,i3 ,.. . . • .,.. . rt/ •,•• Z ' I to\ N. .0 • te N. N. N. N..... ......" I 2z1S.' Inc N. ....,.... ... r- Ur i. -..... 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