HomeMy WebLinkAboutSWG2021-00570 - SWG As-Built - 5/8/2023 CC
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021-00570 Parcel # 32334-75-90031
Applicant Name Emily Davis & Kyle Phillips Subdivision (Name/Div/Block/Lot)
Applicant Address 340 NE Davis Farm Rd.
City, State, Zip Belfair, WA 98528 Installer Name Shumaker Construction
Site Address 299 NE Kissin Tree Ln, Tahuya Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
IS Full System Installation ❑ Tank(s)Only El Drainfield Only El Repair El Other
System Type Shallow Pressure Pretreatment Type
>5 ft. from foundation? - - y v 0 - -"De' kiQ - 0 N/A ❑ YES ❑ NO
>50 ft. from wells? - - ❑ ] ❑
Z >50 ft. from surface water? - - 0 ❑ El
< Cleanout between building and tank? - - - - - ❑ I■ ❑
U Tank baffles present? - -[ {- 114/1 - - - - ❑ El ❑
a24' access risers over each comps nt?- - - - - ❑ ElEl
`lW Effluent filter installed?- ii' -— -%0 z - - - - - ❑ 0 ❑
Septic tank capacity (working) 91'1 00 /anuf. turer Hagerman
D-box water level and speed levele -B- -T:n - ■❑ N/A ❑ YES ❑ NO
08 Manifold/D-box accessible from surface?- - ❑ t[I DI
CO Check valves installed? - - El ❑■ ❑
CSQ
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) El 2 ❑Q 3 El 4 ❑ 5 El 6 ❑Commercial/Other
>10 ft. from foundation?- - - - -N fl- \-ta- Se_s-- Y� - CI N/A ❑ YES ❑ NO
CI >100 ft. from wells?- - El ■❑ ❑
W >100 ft. from surface water? - - ❑■ El
LT >10 ft. from potable water lines?- - El ❑� El
Q Z > 5 ft. from property lines and easements?- - DI ❑■ ID
C > 30 ft. from downgradient curtain/foundation drains?- - ® El El
o
Drainfield level and observation ports present - - El 0 ❑
❑ Graveless chambers or Q Clean gravel used? (check one)
Proper cover installed over drainfield?- - El ■❑ ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A ❑■ YES El NO
• Pump tank capacity (flood) 1000 gal Manufacturer Hagerman
< 24" access riser(s) and accessible from surface?- - ❑ 0 ❑
n. Alarm or Control Panel Installed?
1-kse, ❑ ❑
2 Control Panel equipped with Timer/ETM /Counter- - El U ❑
m
0- Pump installed in ❑ Bucket or ❑■ On Block or El Other
a• Pump Make/Model Liberty 280 I Floats or ❑ Transducer
a.
a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 6 ft
Pump on time 2.3 min Pump off time 6 hr Daily flow set at 360 gpd
'iat,:1 A.75.7C 1
Mason County OSS Installation Report pg. 2
Parcel# 32331{'- 15— `lby 31
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -
YES iii NO
If yes, please describe: NO
Were all components pumped out and properly abandoned per WAC246-272A-C300? - - YES
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 Recorc
Drawings contain: Drainfield&manifold onentation&layout.Septic/pump tank locton,North arrow,reserve drainfield.existing and proposed build rigs,location of wells,waterlines.
wells,observation ports.cleanouts.arc other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
(Se._,Q- '71YA-6 -(k'
111 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that 1 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
!further certify that all information contained on this I further certify that all information contained on this
form and aft e Drawing is accurate. form and attached Record Drawing is accurate.
1 (- 13- 22
n
Signature of Installer Date fi lk
Printed Name of Signee2r. " i,
�,h
MASON COUNTY PUBLIC HEALTH — ',/,
The undersigned approves this Installation Report and .• `P,��
��it' 5100349
Record Drawing on behalf of Mason County Public. PAULA JOY JOHNSON .-7\
Health: b"� • ��z� .
E1PRES /1 /
�.� S/� IZ.� ) (-Zi-2.2
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 upda ed 8!212Or8
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"�'� PAULA JOY JOHNSON `
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APPROVED r I CurvQa -to Go
MAY 0 8 2023 I
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- • MASON COUNTY ENVIRONMENTAL HEALTH /
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RET !L. I xei:
irtI0Audio-Visual Alarm
i
3 Cleanout
— ;• 3 '1200 Gallon Septic Tank
704. IT 2-Compa:rent with
j{6 !, Effluent Filter
1.Nt11 vr tact/laveve
3 1000 Gallon Pump Chamber
1 O Valve Control Box
f (a5 'vi,