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Home My WebLink AboutSWG2022-00084 - SWG As-Built - 10/17/2023 RM Mason County OSS Installation Report pg. 1 MASON COUNTY P BLICO H ERL'T23 _ APPLICANT/ PERMIT INFORMATION KtCEIV Permit Number SWG 2022-00084 Parcel# 12107-33-50010 Applicant Name Rick Buckner Subdivision (Name/Div/Block/Lot) Applicant Address P.O.Box 577 LOT 1 OF LLS#03-03 PTN SW SW City, State, Zip Belfair,WA 98528 Installer Name Shumaker Construction Site Address 2471 E Grapeview Loop Rd Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Q Full System lostallation ❑Tank(s)Only ❑ Drainfleld Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? 0 N/A a YES 0 NO >50 ft.from wells? - 0 II ❑ Z >50 ft.from surface water? - - - - - - ❑ a ❑ FQ- Cleanout between building and tank? 'A._ - A--:----- 0 a 0 O Tank baffles present? - - - -iJ 0 I.1 ❑ S 24"access risers over each compartment? 0 II El W Effluent filter installed? 0 I �Gl-{ - ❑ I 0 Septic tank capacity(working) 1,2,00gnufacfurer Hagerman SI D-box water level and speed levelers used? - - -A a NIA ❑YES 0 NO OIOi Manifold/D-box accessible from surface?- - 0 IIIII 0 m= Check valves installed? 0 IN 0 eQ 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 a 3 ❑4 0 5 ❑6 0 Commercial/Other >10 ft.from foundation?. ❑ NIA In YES ❑ NO c >100 ft. from wells? ❑ CO ❑ W >100 ft. from surface water?- ❑ ® ❑ LL >10 ft.from potable water lines?- 0 a 0 2• > 5 ft. from property lines and easements? 0 a 0 ai > 30 ft. from downgradient curtain/foundation drains? - - - ❑ in ❑ O Drainfeld level and observation ports present ❑ a 0 0 Graveless chambers or Q Clean gravel used' (check one) Proper cover installed over drainfield? ❑ a ❑ Pump tank setbacks consistent with septic tank?- ❑ NIA a YEs ❑ NO Y Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman cc24" access riser(s)and accessible from surface? 0 III 0 ~ O. Alarm or Control Panel Installed? ❑ IR 0 • Control Panel equipped with Timer/ETM i Counter 0 a 0 7 a Pump installed in a Bucket or ❑ On Block or 0 Other a'M Pump Make/Model Liberty 280 It Floats or 0 Transducer 4 Tank draw down 1.75 in/min Pump capacity 33 gpm Squirt Height 5 ft Pump on time 2.7 minutes Pump off time 6 hours Daily flow set at 360 qpd .sca.d".rax> Mason County OSS Installation Report pg.2 Parcel a 12 I 0 'I —5)3— 500 IC ABANDONMENT RECORD Were existing septic components abandoned as part of this project? 0 YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC24O-272A-0300? ❑ YES ❑ NO RECORD DRAWING this Is a permanent record and must M accurate and descriptive enough to r.400ra In the need nl maintenance activities and future development Typical Rowel Drawn-Qs contain. DrainbW&martbld onenaton&layout.Sepcipump tank location.Noah arrow.reserve drain':da w rig end proposed weans.location of w wells.watertnea. welt odtervalvn p3f4 deanaas.and other maintenance access poi-tz Incomplete Recordo,avnn9a mm/rneete addconyChann ena lnLLlazm.epproveland'elated permits- ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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. Signature of11-- ! Date ka \ {—\QY0 \ V`k yv\a Ker c y Printed Name of Signee ."A'rat rt. MASON COUNTY PUBLIC HEALTH a ` 'y ✓.,4y1 The undersigned approves this Installation Report and C,,. -ti;13 • If Record Drawing on behalf of Mason County Public q'^p' PAULA JOY JOHNSON '�on Health: d�: LIcFNSEtl IGNE'n.. f <'icr'tCY`it`\ C<yi IRf$ e t I Signature of Environment / EJtP Health Specialist Date stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upwled 8121/2E18 Bev: / , Audio-Visual AJa Cleanom nick 3 C ht,r '2y 1200 Gallon Septic Task Pareet 12i o7-; -50010 �/ 2-Cempamme';with Effluent F_*e. 2441 >; ( yrvuw I oap Zd 0 1000 Gawon Pump Chamber SCCTIB: I '= Ieo ' U Valve Control.Box 0 $0 100 ISO 200 APPROVED OCT 16 2023 I MASON C3u1,71 EY,r,RCti4.57AL HEAUH l' RET , ce, / h primary D.F. zoo' o /x \i/ 3 ' w1d-el itenckc.5" CO) ci,See dam;y 5 D.C . Cup ved -ro CO 14vr z wi* nerve below. r J :CP riett j w A) /, 0yy PAHLA JOY JOHNSON ';'r / J � ?it i \ L,E: .Wt1-X...A., " / s 1 el - 2`L- 06.74' i j 3eni 1 a tr.:14 .a Dp va ye J II btf_ a r\ FGYjpw \ \ Rd 21431: \\ N %7M.`72.