HomeMy WebLinkAboutSWG2023-00175 - SWG As-Built - 9/18/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number swG 2023 00175 Parcel# 122322200030
Applicant Name Mark Hightower Subdivision (Name/Div/Block/Lot)
Applicant Address 2807 NE Enelai Beach rd
City, State, Zip 1 Bremerton, wA Q 13/0 Installer Name Shumaker Construction
Site Address 391 E Hardings Hill Rd, // )L Designer Name Frank Marcinto
INSTALLATION CHECKLIST
Full system Installation ❑Tands)Only ❑Drainfeld Only ❑Repair ❑Other
System Type gravity Pretreatment Type
>5 ft.from foundation? - - --- ----------- --- - -- - - - - - ❑ NIA YES E] NO
>50 ft.front wells? - - - - - -- - - --- -- - - ------ - - - - - - - ❑
Z >50ft.from surface water? -- - - ------ ------ - - - - - - -- ❑ ❑❑
fCleanout between building and tank? ------------- -- - - - - ❑ ® ❑
t,) Tank baffles present? - -- - - - -- --- --------- -- - - - -- ❑ ■ ❑
iF- 24"access deers over each compartment?-__________ _ __ _. ❑ . ❑
NEffluent filter installed?- - -- - - - - - - - - ------ - -- - - - - - - ❑ ® ❑
Septic tank capacity(working) 1250 gal Manufacturer Haqermon Pre loll
o D-box water level and speed levelers used? -- - -- -- -____ - _ . ❑ NIA YES ❑ No
kO Manifold/D-box accessible from surface?-- -- - - - --- --- -- - . ❑ ® ❑
GaCheck valves installed7 - - - - - - - - - ----- - - --- --- - - - - ❑ ❑
2 Transport Line Size 4' Schedule/Class 3034
Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑CommerciallOther
>10ft.from foundation?-- -- ---- ------------ - - - - - - E] NIA YES ❑ rq
l] >100 ft.from wells?- - -------------------- - -- - - -- ❑ . _ ❑
W >100 ft. from surface water?--- - ------------- - - - - - -- ❑ ❑
Z >10 ft.from potable water lines?--- - ❑ ® ❑
Q >5 ft.from property lines and easements?---- - _ _ _ ❑ ❑
Q > 30 ft.from downgradient curtain/foundation drains?- - - - - - - - _ . ❑ ❑
Drainfieki level and observation pods present -- - - - - - - - - - _ _. ❑ . ❑
❑ Graveless chambers or E Clean gravel used?-(check one)
Proper cover installed over drainfield?-- - - - - - - - - - - -- - - - - - ❑ ® ❑
Pump lank setbacks consistent with septic tank?---- --- - - - - - - NIA ❑ YEa No
ZPump tank capacity(flood) gal Manufacturer j o
H 24"access riser(s)and accessible from surface?- - -- - __-___- . ❑ ❑ m
R Alarm or Control Panel Installed? - -- - - - - -- - - --------- - ❑ ❑
Control Panel equipped with Timer/ETM I Counter--------- -- cm
13
m
a PumpInstalled in ❑ ❑ Otter q
� ❑ Bucket or On Block or i �J-
a Pump Make/Modet r
❑ Floats or ❑Transducer E
a Tank draw down intmin Pump capacity gpm Squirt Height IF-ft
Fft
Pump on time Pump of time Daily flow,set at gpd
I�NMIgIHB
Mason County OSS Installation Report pg. 2 Parcel# 122322200030
r ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -- - - - ❑ YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-03001 - - - - - - - - ❑ YES ® No
RECORD DRAWING
mb M a w^nm.m nwN am muer M-to..M ovilive.nouyx to Moc.a in rM mee M—1-oa rKe.o...ane rurun a.v rri.M 1,,t l n—I
Dnw'mp.ranmi. D�WrW a memlda menbron a lavom.sep4tlpump leak muoon.t♦onn an,.e,reserve tlroinfi.�a,ea:v,a.na Prow:ae wtamaa 1—t-r..ea waletlbrta.
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® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 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 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 deared/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 Masan County Codes
I further certify that all information contained on this 1 further certify that all information contained on this
form and attached Record Drawing is accurate form and attached Record&wing is accurate.
Signature of Installer Date
�me of Sig��
MASON COUNTY PUBLIC HEALTH P
The undersigned approves this Installation Report and 2010080g
Record Drawing on behalf of Mason County Public FraM A Marc raft
Health: LICENSED DESIGNED-
Signature of Environmental Health Specialist Data (stamp, signature and date)
THIS FORM MAY BE SCANNED AIJO AVAILABL E FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE c�W12016
As-Built
Record Of Construction N
+0'el 330' � uawled %'-, +20'el
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nA X x
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SL#1 0 Sand Loam i
32"Compact layer i
1
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SIX2 0"-31"Sand Loam 4% 100%Reserve i
32"Compact layer Area 1
Septic
SLn 3 0"-31"Sand Loam Tank
Future Connection
32"Compact layer ICO i
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I
I
100' X 80' Building i
Envelope For A Three
Bedroom Home
APPROVED
;
'^ 18 SEP 2024
N i N
'^ MASON COUNTY ENVIRONMENTAL HEALTH
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RET
100"Nell Radius I lu
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Septic ROC Name: Hightower Tax Parcel: 12232-22-00030 v
F Scale = I" = 50' Address: 391 E Hardings Hill Rd,Allyn P�3
This is not a survey all pmPeeYlines/boundaries have been demsnstrtsdbythe ...hs)and/or their Agenasl.
On-Site Septic Design I Allied Septic Design and Excavating 20100608
Fralk A AlardMlo
LICENSED DESIGNER
O`J 63 .Z