HomeMy WebLinkAboutSWG2022-00101 - SWG As-Built - 7/11/2023 10,1X0M17,12)7
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Mason County OSS Installation Report pg. 1 BY-------
MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2022 00101 Parcel# 12229-43-00000
Applicant Name Austin&Taylor Shumaker Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 2692
City, State, Zip Belfair W a 98528 Installer Name Shumaker Construction
Site Address 6681 E Grapview loop Rd Designer Name Environmental Design
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑Repair ❑Other
System Type Pressure Pretreatment Type
>5 ft.from foundation? -
•- ❑ N/A ®YES 0 NO
>50 ft.from wells? - - ❑ MI ❑
>50 ft.from surface water? - -
z0 ® 0
HCleanout between building and tank? - - ❑ ® 0
tJ Tank baffles present? - - ❑ ® 0
d 24"access risers over each compartment?- ❑ IN ❑
y Effluent filter installed?- ❑
RI
Septic tank capacity(working) 1250 0
gal Manufacturer Hagermen's
o D-box water level and speed levelers used? -
c -0 Man(fold/D-box accessible from surface? - III N/A ❑ YES 0 NO
mZ Check valves installed? - El I El
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 4 �1 6
>10 ft.from foundation?- --- - -IP if_�_�!� 4 k �n.;, El N/A
-VT - N/A NI YES NO
0 >100 ft.from wells?- ❑
W >100 ft.from surface water? -- {- 0 NI 0
u. >10 ft.from potable water lines - 1111 ❑
42 >5 ft.from property lines and e� rSacsQ E�VVIp(IiJ1NElSfR1'}(ERLfii� El�JN7Y
a >30 ft.from downgradient curtain/foundation d � -
❑ I
0
�ftST
El e 0
Drainfield level and observation ports present - -
Graveless chambers or ElClean gravel used? (check one) 0
Proper cover installed over drainfield?- _ 0 ® ❑
Pump tank setbacks consistent with septic tank?-
- ❑ N/A ® YES 0 NO
ZPump tank capacity(flood) 1250 gal Manufacturer- Hagermen's
< 24'access riser(s)and accessible from surface?- - ❑ I 0
N
a Alarm or Control Panel Installed? - - ❑ I 0
Control Panel equipped with Timer/ETM/Counter- . ❑ ® 0
a Pump installed in ® Bucket or 0 On Block or ❑ Other
a Pump Make/Model liberty 280
® Floats or
0 Transducer
a Tank draw down 1.75 in/min Pump capacity 50 gpm Squirt Height 12 ft
Pump on time 1.Z. IA'fl Pump off time 4 hr5 Daily flow set at be'
gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 12229-43-00000
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - El YES 0
NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES El 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: Drainfleld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve dralnfield,existing and proposed buildings.location of walls,waterlines,
wells,observation ports,deanouts,and other maintenance access points, Incomplete Record Drawings may create additional delays in final installation approval and related permits.
1
APPROVE
JUL 1 1 2023
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
‘FILFecord 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.
—ram f4'14.00'
Signature of installer Date it it
Printed Name of Signee .� `et x.4•.1.:�
..$tit .. ..
MASON COUNTY PUBLIC HEALTH ��''
The undersigned approves this Installation Report and '��,> -• Stl;: •3
�,..� • :::: J.y J.Hie or :y
Record Drawing on behalf of Mason County Public rt'4'cg . fill.'•
He 4.L.c.u. N., n•l:Qc'1
txPrra 3 `
J,L i-it_�3 nVV�
Sign r l vironmental Health Specialist Date
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
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