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HomeMy WebLinkAboutSWG2024-00057 - SWG As-Built - 6/3/2024 Mason County OSS Installation Report pg. 1 A� MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00057 cat# 22325-50-03010 Applicant Name Luisa Garcia division(Name/Div/Block/Lot) Applicant Address 61 NE Rainb n 4 City, State, Zip Belfair,WA,9% MAI Inst ler Name Shumaker Construction Site Address 61 NE Rainbo Ln ner Name Acme Septic Design INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Standard Pressure Pretreatment Type >5 ft.from foundation? ------------------------ --- ❑ MIA AYES ❑ NO >50ft,from wells? ----------------------------- ❑ ❑ z >50ft.from surface water? ------------------------ ❑ ❑ FCleanout between building and tank? ------------------- ❑ U Tank baffles present? --------------------------- ❑ F- 24"access risers over each compartment?---------------- ❑ N ❑ a w Effluent filter installed?--------------------------- ❑ ❑ ❑ n Septic tank size 1500 oat Manufacturer Hagerman 0 D-box water level and speed levelers used? --------------- ❑ ran ❑YES NO p0 Manifold/D-box accessible from surface?----------------- ❑ El mZ Check valves installed? -------------------------- ❑ ❑ 0< 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed(check one) ®2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10ft.from foundation?-------------------------- ❑ wA Ores No 0 >100 ft.fromwells?----------------------------- ❑ ❑� ❑ w >100 ft.from surface water?------------------------ ❑ 0 ❑ ti >10ft.from potable water lines?---------------------- ❑ ❑� ❑ Z >5ft.from property lines and easements?---------------- ❑ ❑ a ❑ ❑ tr. >30 ft.from downgredientcurtain/foundation drains?---------- 0 Drainfieltl level and observation ports present -------------- ❑ � ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfeld?------------------- ❑ Pump tank setbacks consistanl with septic tank?------------- ❑ WA 0 YES ❑ No Y Pump tank size 1000 gal Manufacturer Hagerman Q24"access riser(s)and accessible from surface?------------- ❑ ❑ f a Alarm or Control Panel lnsfalled? --------------------' ❑ � 2 Control Panel equipped with Timer/ETM/Counter--- -------- ❑ 0 ❑ 0- Pump installed in ® Bucket or ❑ On Block or ❑ Other a Pump Make/Model Liberty 280 Floats or ❑Transducer a Tank draw down 2 in/min Pump capacity 44 gpin Squirt Height 8 ft Pump on time 40 Sec Pump oft time 3 Hrs Daily fiow set at 23g.9 gpd upn mwiwimii Mason County OSS installation Report pg. 2 Parcel a 223255003010 ABANDONMENT RECORD Were existing septic wmpanents abandoned as pan of this project? ---- ---------- - we NO ff yes, please describe:enistino septic tank was decomissioned Were all ma ponems pumped out and properly abandoned per WAC246272A-0300? ---- - - - - ® YES NO RECORD DRAWING ad.in•prtmwm nrom and must e.ea—.aM mecnn—+noose in m4-4a m ua n«a ur mmnuen.ns.aamuea and mw,.Oev.bpnml. TO-1 RN,otl Pa'x rgs.—an .Tsn,.J 3 maoilWtl onenfa[Y 6 tryout S,,TONmp ark 11 itw.Noh—reserve Jr-f y,erisfN end prop—WYdings,Juana of mads.w well.onvervam pony Wmnws antl oMa mvN�pngrxx a¢ecy Binh. innpmpble RECON 9rz a w � my n a ryl l eu n i ie wings ry y ae atlQYImN 4Vey.I r syelblb epww o re aiev yrvm Record 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 Masan dance with the septic design stamped'APPROVED"by County Public Health and that any deviations shown Meson County Public Health and that any de Nations here have been deared/approved by both the designer shown here have been clearerf/apprpved 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 an this farm and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signsttfure of Installs, 1 Dare Pnnted Nance of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public terT Haeitn: /// uce/sao sardER r� �('� E%PIREa 12r151 Sigma Qlhne`o�t EY�n('' )vuonmavA•^Y, I Heafthry LSperJ10'alist /Late (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC MEW ON THE MASON COUNTY WEB SITE § ) ) k § \ ) Ioc m feeee ® , ` ` m > m ] ; k m S ( 2R S 07 § ` En . z \# § 2 G \ z cn � 5 ;u cn m k m m § \ / 2E § ---i m G) aj m4y92f \ \ \ -0 D z oo O \ § / E & § $$ 2 \ gzlr ) ma q « � @ \ ] m ) �/ it § 2 a2 S � \ ) � § \\ { % \ 2 \ S k . ) 7 $ m - / ƒ a $ m mm ) \/ 7 � % . eeee %(j \) \§ M \ §o o N \| Q ; § \ � , m ©\ m \ \ § \ $k my § m ) m ? » < ; ® 2 ° \\ § � } \ \ k \ \ za = m � » mERAImo.g � § \ � � 0z M � \ / O - r- \ / 2 � o } (, m w to ~Gm t j 72 . 2m