HomeMy WebLinkAboutSWG2021-00589 - SWG As-Built - 8/7/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SwG 2021-00589 Parcel # 32207-50-00930
Applicant Name Kim DeFrlese Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 2936
City, State, Zip Belfair, WA 98528 Installer Name Shumaker Construction
Site Address 20922 NE North Shore Rd Designer Name Arrow Septic Designs Inc
INSTALLATION CHECKLIST
Full System Insallahen ❑ Tankfs) Only ❑ Drainfield Only ❑ Re air ❑ O:he' Li1Pump�i 0002—v
System Type Subsurface Drip Pretr ant Type Nu Water BNR-500
15 ft from foundation? - - - - - - - - - - - - pp Iq� (�y1�� D ❑ NIA O YES ❑ NO
>50 ft. from wel'.s? - - - - - - & ❑ ❑� ❑
z >50ft. fromsudacewate0 - - - - - - - - - - - -YU2624- ❑
H Cleanout between building and tank? - - - - - - - -,(- - - - - -
❑ 0 ❑
U Tank baffles present? — - - - - - - - - - - 8- - - ♦4- - - - - - - ❑ Q ❑
IL
rt 24" access risers over each compament?- y -- - ❑ Q ❑
w Effluent filter retailed? - - - - -
Ij,')'Au - - - - - - - - - - - - - ❑ ❑ O
Septic tank capacity(working) BNR-500 gal Manufacturer Hagerman
D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ❑ YES Q NO
J
00 Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - ❑ � ❑
mZ Check valves installed? — - - - - - - - - - - - - - - - - - - - - - - - ❑ Q ❑
oa
f Transport Line Size 1" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 O 3 ❑4 ❑ 5 ❑6 ❑Ccmmercla!Other
>10 ft from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA OYES ❑ NO
O 1100 ft. from wells?- - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑
W >100 ft from surface water? - - - - - - - - - - - - - - - - - - - - - - - - ❑ X
LL 10 ft from po:able water lines?- - - - - - - - - - - - - - - - - - - - — ❑ A ❑
Q > 5ft. from property lines and easements?- - - - - - - - - - - - - - - ❑ A ❑
C >30 ft-from downgradient curtain/foundation drains? ❑ ❑
Drainfield lave:and observation ports present - - - - - - - - - - - - ❑ ❑
r� GEE tijE]
Proper cover installed over drain lit?- - - - - - - - - - - - - - - - - ❑ ❑ ❑
Pump tank setbacks consistent with septc tank?- - - - - - - - - - - - ❑ NIA X YES ❑ NO
ZPump tank capacity(flood) 1,000 gal Manufacturer Hagerman
H24" access risers)and accessible from surface? ❑ m ❑
a Alarm or Control Panel lostalled? - - - - - - - - - - - - - - - - - - - - - ❑ Q ❑
Control Panel equippec with Timer/I/Counter ❑ 0 ❑
7
d Pump installed in ❑ Bucket or ❑ On Block or O Other Flow Inducer
a Pump Make/Model Orenco PF 200512 ❑� Floats or� ❑ Transducer
4 Tank draw down 1-5/ 10 min in/min Pump capacity 2-85 gpm Squirt Height - ft
Pump on time 10 min Pump off time 2 1 Daily Flow set at 340 gptl
Mason County OSS Installation Report pg. 2 panel t: 32207-50-00930
ABANDONMENTRECORD
Wore existing sepfic comooeenm abandoned as pa', of tro pre)eH9 - - -- - YcS Q NO
If ves, Please describe:
Ni ere all compocenue pumped out ano prcperly abandoned per\NAC256-272A-0300? - - - - - - - - ❑ YES ❑ NO
RECORD DRAWING
.m— <o .m m .:c.ncn—a a<.e a.:orl,—a e<zn m,.a.<,...<a.r...of.. ewr< .<w;ti...m m�,e a..xowre�.. T,p aar Rxor
cl, .I,—a s: u.I.o. .G v -In,oc _r— ,I"yzr an,1r s.1,,r v."—
r5E'vB.xrl v_.n+EDI rts 1,am.l..3 .mngs CS�c as _,rl x A."In" In rul Vx_,am
1
SEE /�T-V WEP
Record Dnat✓in9 Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
certify that I,stalled the system in accoruarrue wlth I eemfy that the system,has bee' nstahea. . or-
bs septic design Stamped APPPCVED" fA-son dance with the sapec easier slam
y p APPROV D'py
Count Pubmc Health and that a y deboth /e shown Na on County Public Health and that any deviations
Gave bee c1, %tilt,Haelarra 11 by help ..-.e des'r+er shc—hat have been cleard/approved by both
t e '_A son Co ry. a bl c Hea i and n e aG Sa,e myself and Mason County ubr:c ut alth end meet al(
a rr ce cc t / des State and Mason Coanly Codes
r m7ner ce.�fy ra 11 „cr a I r o a,_, T this I Further cam y drat a/I,forma for slill,ed on tnls
o m a ,d a3ta eo Recor Or em s e c•-a.e. Record Drs b
_ 9 s form and attached g s acc 7.
._.
25 Y
11 Oe;e
P IPd!J2.Te 1,T SyJ, ee � r P
g♦ f
MASON COUNTY PUBLIC HEALTH CCU' m�JrVti
sletitahu eea"p, � ``*•,S1..FT , .m"11 e ord Draw og or. a=hal. t P les ^ Co�tim}r7ub m `r u c
' e (j PFUU OY JDHNSOh ';
m ' `�cllK`N$EOUESIt.NCa' S
Sdoatue or cnvironmentJ Hea/th Speciellst Gene ��Z�
(stamp,�fgnetura end lode)
-----------------------------
ORM MFll8E5 NJEDALCAJAILAB_E FOR PUBLIC VIEW CK THE VSON COUNTY Wce Sl-= 4'-In-+
wo'
PcmGry As autcT
IRes:rve Lr''S r1, 1 ',dfok nFi(18 K rn CP-�r1'ieS '�
P
for ��ri*t oarcna- 32w7-5o9a930
b75sgH Drm oe 7rr,�— 2za7-s 0 I'
T Z
V 09ZZ h c NofTh ShotP Rc
uopc j n
Old Rogd I „�
i e Zp so 75
I
FY'0 oScd �
I drew
40
3a PpoPeSed 100 '.
Cd 3'
Audio-Usual Ala_'-m — SoQh
70.
� i
Cleanont
Parcel3zzo� s° " ex;s.;ry �
4G Q 3 0 �n e!I J� �I\ 3 500 Callon Pre-Traah Tenk
^' C -N Wacer B\R-50O Pretre=eni Ta.'1H
XI
bo ?GArSv ni 1,000 GBIlOR Pump Chambe-
Nti Nof;h Shore ,� �_
(-6) S-absurFace 7,.F Spsten Heedworks
� I
� Ilr:-� puvNp ' n �Crcnd (tiomia>,r
AqZIOSOF—ZAS
v3
tBR
Ufa N
APPROVED
farCCI#S 22oi-SC,
AUG 01 2024
�A
1 P_ANIN JOY JOHNSON ;1�
gars o�riy
7 3 t4