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HomeMy WebLinkAboutSWG2022-00508 - SWG As-Built - 5/16/2023 1 Mason County OSS Installation Report pg. 1 Q., MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00508 Parcel# 32335-50-00001 Applicant Name Andy Skaran Subdivision (Name/Div/Block/Lot) Applicant Address 1916 50th St Ct NW TEE LAKE SHORE ACRES TR 1 S 43/154 City. State, Zip Gig Harbor, WA 98335 Installer Name Shumaker Construction Site Address 371 NE Tee Lake Rd,Tahuya Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ infield Only ❑ Repair ❑ Other Soo gallon pre-trash tank System Type Shallow Pres Pretreatment Type NuWater BNR-500 >5 ft.from foundation? - 4--- 'fit-- - ❑ N/A IN YES ❑ NO >50 ft. from wells? - ..' - PI ❑ Z >50 ft. from surface water? - c.)----- III < Cleanout between building and tank? - ® ❑ V Tank baffles present? - - -- Y - ❑ IN ❑ a24" access risers over each compart ent?- -- --- ❑ ® ❑ ILI Effluent filter installed?- - S - ❑ 1. ❑ Septic tank capacity(working) NuWater BNR gal Manufacturer Hagerman r D-box water level and speed levelers used? 0 N;A ❑ YES El NO p0 Manifold/D-box accessible from surface?- - ❑ ❑ m- Check valves installed? - c - 2.u_l.t► cAcz - - - - - ❑ II ❑ - - OQ Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ NiA ® YES ❑ NO CI >100 ft. from wells?- - 0 ® 0 W >100 ft. from surface water? - - ❑ E. ❑ I u. >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z > 5 ft.from property lines and easements?- - ❑ ® ❑ Q ce > 30 ft. from downgradient curtain/foundation drains?- - ❑ © ❑ to Drainfield level and observation ports present - - ❑ II ❑ a ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ • ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A . YES ❑ NO Y Pump tank capacity(flood) 1,200 gal Manufacturer Hagerman Z Q 24" access riser(s) and accessible from surface?- - ❑ © ❑ t^ a Alarm or Control Panel Installed? - - ❑ 0 ❑ 2 Control Panel equipped with Timer/ETM /Counter- - ❑ • ❑ m a Pump installed in ❑ Bucket or ❑ On Block or 0 Other bucket EPump Make/Model Liberty 290 0 Floats or ❑ Transducer d Tank draw down 1.75 in/min Pump capacity 38.5 gpm Squirt Height 4 ft Pump on time 3 minutes Pump off time 6 hours Daily flow set at 462 gpd l;pdated n;21!2018 Mason County OSS Installation Report pg. 2 Parcel# 3Z 55—SQ^O ) I ABANDONMENT RECORD NO Were existing septic components abandoned as part of this project? - - E YES JJJ""��� If yes, please describe: YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 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. Dra.nfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,eidsting and proposed buildings,location of wells.waterlines, wells,observation ports,dearouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final 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 att el Re Drawing is accurate. form and attached Record Drawing is accurate. 0425 AP. Signature of installer Dot .reV\,j k kN Asa:-• ;c` -#. Printed Name of Signee '`°' ' •'lr� MASON COUNTY PUBLIC HEALTH ‘ The undersigned approves this installation Report and i-:�• st��3.aa q{+llll O PAULA JOY OHNSON :y t Record Drawing on behalf of Mason County Public IiC :fir d �IGNEI ?- -� Health: EXPRES risr C-7M 511(0(?: 5,4,—z.s Signature of Environment Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8212ota L NY.E tAI: i ' =50f r • 0 25 6c ?5 b;t �, •W I 31 i tvZ Zee. L4ke Rei 8 t , ` i �5tr- oa�o\ 5� �� v` gcx , r � '� futa i5f. . I C(v\-3L X 4- ' Pr;ivar' 91 I I -11 sue t 1 .F . �'/ y.` •t i i ,f`ii: 5,o0349 •.gltsi --fo' PAUt.A.13Y JOHNSON . ` • � '9 LIMIRISEfibESiON ft• 6aiXsPLw. lriLC C\� ® I S - '-f-23 i NC 00` : i . o=�is""; A / clealsoue • 500 won Pre-Trash k s 1 . ( 50 ` jI ' U/2"..Nu a'cer BNR 500 ATU Tank H I �. C,ZOC :?o�Pump Chamber 53 , , U V � ��,�o.Box r- w i se v ,lc_ -}o,,w t w i-E`er ¢{=F 1.4206. • N \o4. Yoom i 4 i 1 e✓ T4 .`,-I,c,MSe.r-•} ?le— icc_,,,e,i,,,At. i,esef NI/1 APPROVE No FOUNDATION DRAIN MAY 16 2023 �� EBDOWN ERVEGRADIE�OFMASON COUNTY E'MRQNMENTAI H LD • • RET EALTH