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HomeMy WebLinkAboutSWG2023-00174 - SWG As-Built - 9/27/2023 _` / Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00174 Parcel# 12317-14-00040 Applicant Name William Hoychuk Subdivision (Name/Div/Block/Lot) Applicant Address 2341 NE Old Belfair Hwy TR 4 OF SE NE S 53/25 City, State, Zip Belfair, WA 98528 Installer Name Shumaker Construction Site Address same Designer Name Arrow Septic Designs INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only El Drainfield Only I♦ Repair ❑Other System Type Pressure Trench Pretreatment Type >5 ft. from foundation? - - ❑ N/A ®YES ❑ NO >50 ft.from wells? 5 - - Th f U 1E ` ❑ 0 0 • >50 ft.from surface water? - ' 0 I ❑ Z Q Cleanout between building and tank? -- --S-E-P-1-3-2-023-`t - 0 I O Tank baffles present? - -/- -'" ❑ 0 0 a24" access risers over each compartmen' - -\ - El ❑ W Effluent filter installed?- ❑ 0 0 N Hagerman Septic tank capacity(working) 1,200 qal Manufacturer 9 9 D-box water level and speed levelers used? - - IIN/A ElYES I: NO p0 Manifold/D-box accessible from surface?- - ❑ IC D mZ Check valves installed? - a `. k 9 '"'� � � - 0 IN 0 0Q 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 El 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ®YES ❑ NO O >100 ft. from wells?- - 0 C. ❑ W >100 ft. from surface water? - - 0 RI EL- >10 ft.from potable water lines?- - 0 © 0 i Z > 5 ft. from property lines and easements?- - 0 © ❑ cc > 30 ft.from downgradient curtain/foundation drains? - - ❑ ® ❑ O Drainfield level and observation ports present - - ❑ I ❑ 0 Graveless chambers or LE Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ E ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A © YES ❑ No • Pump tank capacity(flood) 1,000 qal Manufacturer Hagerman < 24" access riser(s)and accessible from surface?- - ❑ 0 ❑ a. Alarm or Control Panel Installed? - - 0 0 ❑ a • Control Panel equipped with Timer/ ETM/Counter- - ❑ 0 ❑ a Pump installed in 0 Bucket or 0 On Brock or 0 Other a• Pump Make/Model Liberty Le 51 El Floats or 0 Transducer a. a Tank draw down 1.5 in/min Pump capacity 29 gpm Squirt Height 6 ft Pump on time 3 minutes Pump off time 6 hours Daily flow set at 360 qpd Updated 8/212018 Mason County OSS Installation Report pg. 2 Parcel# 12317-14-00040 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES [] NO If yes, please describe: - A-0 \D-e_ ssctr Q&L t8' Sud-k' eLe. ct3.004,42tm4 . 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 re-locate in the need of maintenance activities and future development. Typical Record Drawings contain-. Drainfiekt&manfolc orientation&layout.Septrc/pump tank location.North arrow,reserve drainfieid,existing and proposed buildings,location of wells,waterlines, waits,observation ports,deanouts,and otter maintenance access points. incomplete Record Drawings may create additional delays in f nal installation approval and related permits. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER l certify that I installed the system in accordance with !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 Rec ing is accurate. form and attached Record Drawing is accurate. /2—I I • ature of installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH � ='•! �, ' ...0 The undersigned approves this Installation Report and ,: ` Record Drawing on behalf of Mason County Public s PAULA JOY%3JOyNSON y�r Health: L49 'ICEWS `lti8S ry` (L- .1,1C ExPif�U,LW 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 6212018 • • • (4 ,,,,_ ft• Y -- _ . Pf i 440•IZS' - ..it p. * --c•,- _. 6-1 1 =•---••--1----71,0 1 giti nal cli.. 3.,Its csurivcr-i ' ioscivitgaIeexacc'i. i 4r , ap av att. Yank 1 - 1 ,..:. zoo' 1.4.0-1. .. C r. 12.311.4-1A-CACAO WO" 114 ws •e4 •e k ? 2**%1WEV41' 1 1 2.5iM Nt 0 ..k‘Al f Vo 4.57-c€s-rkxs ic-„,K.E. . 4-).. . . , Ls, -14'-cro"GLs ,ofs -,-. , \ • -,1_,-- 0-trio° c.4 Ls ' \ \ ------' , „t-5. 0-6(p" AL-ro_tsitcnistc, 7 ti • ......AN1ER5 47 FL 4 V C7LS - • ......-- Kkii \ Nr 1 i '' -* SLSSvg , WA-rEIZLI NE . • e---' • 4. . ".i• e.Ant-otk%'"Atrdt :., Aer ,..• !go --!--1 0 Audio-Visual Aiann e; ,., . 3 Cleanout -*Sci 5-4i rig i 1 IQ (1\ 1200 Gallon Septic Tank clam fii 14 kAs I i ,i: \ 1 2-Comparimient with Effluent Flitt`r OVA ablarWifti. 1 a 1000 Gallon P=p Chamber *%iffibl? it h K /: i j r / APPROVED itkt6 4 • = 1 tieroMMokict. 1 ' 1 / 1 SEP 27 2023 I MASONt COUNTY ENVIRONMENTAL li.i•A V4), ' '',/,/:••_•3 z 0 ',.'" -."-L'' I RET ,:',1-` • 0.44 `tl. t .' at . • _1Y ig- , +Or*. - •---,. ' 'g' Pi 510 I ,,, • ._:1349 :i it• - E • 4 .-f.,?.....PAULA JOY JOHNSON A... 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