HomeMy WebLinkAboutSWG2023-00373 - SWG As-Built - 7/21/2023 Mason County OSS Installation Report pg. 1 C6.._., MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00373 Parcel # 12329-75-90071
Applicant Name C Estrada I Inc Subdivision (Name/Div/Block/Lot)
Applicant Address 11659 SE Black Rd LOT: B OF SP#1748 AF #476303 PTN OF SW S 10/95
City, State, Zip Olalla, WA 98359 Installer Name Shumaker Construction
NE
Site Address 51 X Maple Wood Ct, Belfair Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
• Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type Shallow Pressure Pretreatment Type
>5 ft. from foundation? - - -- - 0 N/A 0 YES ❑ No
>50 ft. from wells? -- - - - -- - - - ❑ U ❑
Z >50 ft. from surface water? - - - IC CI
H Cleanout between building and tank? - - ❑ I El
U Tank baffles present? - - ❑ a ❑
a24"access risers over each compartment?- - CI 0 ❑
W Effluent filter installed?- ❑ o ❑
to
Septic tank capacity (working) 1,200 gal Manufacturer Hagerman
0 D-box water level and speed levelers used? - - 0 NJA ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- -- - ❑ In
m— Check valves installed? - ❑ a ❑
0<
2 Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed (check one) ❑ 2 0 3 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- -- -- - - ❑ N/A [U YES ❑ NO
CD >100 ft. from wells?- - - -. -- - ❑ O ❑
LLI—t >100 ft. from surface water? - ❑■ 0
❑
LL >10 ft. from potable water lines?-
- ❑ O ❑
Z > 5 ft. from property lines and easements?- - - - -
IN LI
IY > 30 ft. from downgradient curtain/foundation drains' - - ❑ 0 ❑
0
Drainfield level and observation ports present - - - - ❑ iii ❑
❑ Graveless chambers or ® Clean gravel used'? (check one)
Proper cover installed over drainfield?- - - - ❑ 0 ❑
Pump tank setbacks consistent with septic tank?- - - Li N/A ❑ No
® YES
Pump tank capacity (flood)_ 1,000 gal Manufacturer Hagerman
Z
< 24' access riser(s) and accessible from surface?- - - - - ❑ E ❑
~ Alarm or Control Panel Installed? ❑ 0 ❑
a.
jControl Panel equipped with Timer/ETM/Counter- - - - -- - ❑ El
- Pump installed in 0 Bucket or ❑ On Block or ❑ Other
a' Pump Make/Model Liberty 280
❑ ❑ Transducer
A Floats or FrF'lov F F in/min Pump capacity 38 gpm Squirt Height 6 ft
Pump on time 2.33 min Pump off time 6 hours Daily flow set at 360 gpd
JUL 2 1 2(123
Updated A/27,20 1 8
MASON COUNTY ENV;RONMEilTAL HEALTI
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Mason County OSS Installation Report pg. 2 Parcel# 1�32-9 •- 75- 1oo 11
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES tik NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES � NO
RECORD DRAWING
This Is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development. Typical Record
Drawings contain Dracd;eld a.marrtold Orientation d.layout,Septepump tank location.North arrow,reserve drainfield,existing and proposed build ngs.location of welts,waterlines.
weals,obsorvator ports.ceanouts.and other marntenana,amass ports. Incomplete Record Drawings may create additional delays in final installation approval end related pencils.
C .
21\Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with l 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 R or awing is accurate. form and attached Record Drawing is accurate.
O5/U /2.S
Signature of Installer date
A
ArcZ.�� S l ,w�.,k-e.r s .K�;
Printed Name of Signee APPROVED C i t
n
FrAMASON COUNTY PUBLIC HEALTH 2023 `` l \^
II IIr it`. r•••. .r
the undersigned approves this Installation Report ffd 2 • 4 -;. ' .*:-
r 1:) 1.
Record Dr i g on behalf of Mason Coun p ��I s on34g
Health: MAS N GtUUN I T ENVIF ONMENTAL HEALTH pnV�A ty JOY rJ41,4 N`?�?`
/zi/wjDAA s' sr,•3; -c
•
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 Updated nrz1,20 to
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-P4rcei*I2329-75- 90071 I
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APPROVED
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JUL 2 1 2023 ____________
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MASON COUNTY ENVIRONMENTAL HEALTH I TT
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0 Audio visual Alarm pj _.O
Cleanout ,,Jl L�
,4. ..-- 0 -
33 1200 Gallon Septic Tank .37 - ''. --=
2-Compartment with �*
Effluent Filter *71
0 1000 Gallon Pump Chamber •
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O5 Valve Control Box '�0
ell v
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