HomeMy WebLinkAboutSWG2022-00265 - SWG As-Built - 4/10/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00265 Parcel # 123325200002
Applicant Name Chris Trotter Subdivision (Name/Div/Block/Lot)
Applicant Address 2915 12th St PI SW
City, State, Zip Puyallup Wa. 98373 Installer Name Shumaker Construction
Site Address 51 Daybreak Dr. Belfair Designer Name Kevin Hughes
Q. G )t(.A INSTALLATION CHECKLIST
III Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other
System Type Pressure Pretreatment Type
>5 ft.from foundation? - •- 0 N/A III YES 0 NO
>50 ft.from wells? - - 0 ® El
Z >50 ft.from surface water? - El
FQ- Cleanout between building and tank? - - El _-
U Tank baffles present? - - 0 i 4PR 7 g,
d 24"access risers over each compartment?- -• - 02
3
W Effluent filter installed?- - ❑ h'EC - ❑
cn
Septic tank capacity(working) 1250 qal Manufacturer Hagermen's D
a D-box water level and speed levelers used? • - ® N/A 0 YES ❑ NO
00 Manifold/D-box accessible from surface?- - El I El
cQ Z Check valves installed? - - ❑ 0 IN
❑Q
2 Transport Line Size 2": Schedule/Class . 40
Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A i YES ❑ NO
In >100 ft.from wells?- ' 0 IN 0
W >100 ft.from surface water?- - 0 III 0
u. >10 ft.from potable water lines?- - ❑ ® ❑
Z > 5 ft.from property lines and easements?- - ❑ PE El12 > 30 ft.from downgradient curtain/foundation drains?- - ❑ U ❑
ca
Drainfield level and observation ports present - - El ® ❑
❑ Graveless chambers or no Clean gravel used? (check one)
Proper cover installed over drainfield?- - El II ❑
Pump tank setbacks consistent with septic tank?- - ❑ NIA ii YES ❑ NO
Y Pump tank capacity(flood) 1000 gal Manufacturer Hagermen's
Z
< 24"access riser(s)and accessible from surface?- - ❑ ® 0
G. Alarm or Control Panel Installed? - - - ❑ PI ❑
Control Panel equipped with Timer/ETM/Counter- - 0 II ❑
a Pump installed in ® Bucket or 0 On Block or ❑ Other
2 Pump Make/Model Liberty 280 Floats or 0 Transducer
d Tank draw down 2" in/min Pump capacity 50 _gpm Squl/Mig it°2023 4 ft
Pump on time 2.2 min Pump off time 6hr Daily flow TAl gpd
MASON Gunn I 1 t1d'JIROT Updated 8212018
Mason County QSS Installation Report pg. 2 Parcel# 23325200002
ABANDONMENT RECORD
Were existing septic components abandoned es part of this project? - - E] YES ® NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 NO
RECORD DRAWING
This Is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development Typical Record
Drawings contain Drainileid A.manifold orientation 8 layout,Septic/pump tank location,North arrow,reserve dralnfiaid,existing end proposed buildings.location of wets.waterlines,
wets,observation ports,cleenouts,and other maintenance access points. incomplete Record Drawings(nay create additional delays in trial Installation 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 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.
7(6. 1/21_ OYHv�R Signet re of Installer Date J� Of WA �y
gt..s44,246„.----
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Pr/n ed Name o ignee >
MASON COUNTY PUBLIC HEALTH `'A ED • 0,
The undersigned approves this Installation Report and / / %% �' ° -.O ,
Record Drawing on behalf of Mason County A 'PROVFD
l' IONA
Health:
/14 y/a7/64,.? r' 3/2 i /zSignatu, of En ' nmental Health Specialist Date R U 2023 (stamp, signature and date)
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is Septic Record Drawing .. ar n>m l Q ° th) TEAM HUGHES
y Mason County,WA crWF. oe. 1T,
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