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HomeMy WebLinkAboutSWG2021-00251 - SWG As-Built - 12/4/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY P LI V TH APPLICANT/ PERMIT INFORMATION R �'1(a,? Permit Number SWG 2021-00251 Parcel # 22211-50-00015 kp Applicant Name Kevin Rogers &Amy Asbury Subdivision (Name/Div/Block/Lot) Applicant Address 28700 34th Ave S#F4 City, State, Zip Auburn, WA 98001 Installer Name Shumaker Construction Site Address 16921 E State Rte 106, Belfair Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST It Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ® Other Upgrade-move DF across hwy System Type Shallow Presure Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ No >50 ft. from wells? - - - MP Ill Z >50 ft. from surface water? - - - -25 �'� , ,j -t'- ❑ ❑ 0 HCleanout between building and tank? - ❑ 0 El U Tank baffles present? - �''( _��C 4-`023 ❑ ❑� ❑ a 24" access risers over each compartment?- W. ❑ ` 0 ❑ W Effluent filter installed?- i -- •_v . 1 0 ❑ N Septic tank capacity (working) 1,200 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ ■❑ ❑ co Check valves installed? - pu --l-0.k". ... - ❑ ❑■ ❑ aQ E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO CI >100 ft. from wells?- - ❑ ■❑ ❑ Li, >100 ft. from surface water? - - ❑ 0 ❑ ti, >10 ft. from potable water lines?- - ❑ ❑I ❑ z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q C > 30 ft. from downgradient curtain/foundation drains?- - ❑ 0 ❑ o Drainfield level and observation ports present - - ❑ 0 LI ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑■ YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ I. ❑ a Alarm or Control Panel Installed? - - ❑ 0 ❑ E Control Panel equipped with Timer/ ETM I Counter- - ❑ I ❑ D a- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other ci' Pump Make/Model Liberty LPFLH61M-6/10hp, 115v El Floats or ❑ Transducer 2 a Tank draw down 2.25" in/min Pump capacity 45 gpm Squirt Height 4 ft Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd Upoated 8.212018 222 O 11- SO Mason County OSS Installation Report pg. 2 Parcel ABANDONMENT RECORD • YES ElNO Were existing septic components abandoned as part of this pro ec?? ©� If yes, please describe: ��� � ��c.•.. S 111 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 :ank locaron,o 4ocate in Nortb arrow, eserve dra fieIC ensang and proposed b need of maintenance activities and uildings,IOre OSGo.'1 of well watertines, Drawings contain. Orts, le &manifold and other maintenance access points. Incomplete Record Drawings may create additional delays in final instaAation approval Zki)a.-Wis' ® 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 att eel-Re Drawing is accurate. form and attached Record Drawing is accurate. --,---- Signature of Installer Date 'ACLNre\A kko\Y\ —C-r A Printed Name of Signee ''O'C' .� MASON COUNTY PUBLIC HEALTH a .*v tVA,The undersigned approves this Installation Report and y `t,, ' ♦. •P,t� Record Drawing on behalf of Mason County Public 51,)o349 •''e,`�.i L'Igh.f-3KfitfCtirSNE-ft PAULA JO' JOHD75ON •y \1)tr\SUNWOV1 Health: ] ,( I vl .. t2,-�-L3 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 upmetl an'not8 100,E J ''h'°'7\ "-;-- -%-k46'./ . . ik A 25 (Str wa�vrr) waII — 331 oN V-r W 5y It.S Oa' / Via-jig b 0% Sc1c '° =/G' '4P�R®V�� ID `° _° 30 � DEC 18 2023 3�P�`.� s- z,,,•,; ._ :,0� - MASON COUNIY E,ti'rIRON,MEhiAI HEALTH v.-v\_ .-0 it s b RET i�eil c S c'c'. ` �� z toy Audio-Visual Alarm • Yt Cleanout • O3 •1200 Gallon Septic Tank=Tf G ti C f a `�� 2-Compartment with ��c f w6/ ,i. l ' h Effluent Filter �f.' Chamber— G� d 4-r�= 5'O0'34YJO •. Jl O1000''�allon Pump Tl o C r p.. .PAUTA JOY JOHNSO. , ,� �GG�SS F `- �� O Valve Control Box — t e- _ kiwis � �'�✓, 1 Z,-%4-2-3 — F. Sia-Fe R ov-te 1 0 b--` t . --__________ 44 ./t...' 3o S c A-e,.„- Qp9.v..1.. .g2ArNZo1ersA % 11/46,-, 0-?- 3� 5�0� ?arr-?i#ZZ21T-5°-0oal5 ,E,o1_1 14, 121( % HWY 1 C) , 8rlair wA '785. . � �- 1-�: f'' , � 0 ' l j ! ! c t 5 1 a r s 30 y5 6c 1 5% S lope_ 4 -Tes - He/t IN -4;N 3 '" Sa nc1 y S f 1 f loaVvl wf r004S,- f0 rn % la 4/^' 3Lt`` J.'a n dy Silt loam ' w/ roots -i_a rY;o-f- . iht- (7) 3/X4 of 0) 31 xZ 1t s Pf;wir clra1 ►1 elci co -- w ;A-h r-eStrvc cabOW — -1sL_s , C,S3 Ste. i y y 1 0:1:kt 1 0);•.4%., APPROVED /////- • MASON COUNCTEYCEhV11R8UhM3hTAL HEALT; <;i fN ��� .- i ti::1 a s, � \ 349 :, g4.tZiLlgYbgaerN'itN,)N. 1 l 2,-4-2-3 ..