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HomeMy WebLinkAboutSWG2019-00424 - SWG As-Built - 10/28/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2019-00424 Parcel # 22114-23-50010 Applicant Name Donald Roe Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 957 TR A OF SURVEY VOL 3 PG 88 PTN OF SW NW City, State, Zip Belfair WA 98528 Installer Name Shumaker Construction Site Address 440 E Thomas Rd Grapeveiw WA Designer Name Arrow Septic Des ins Inc INSTALLATIQN'CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair Other uun.zore System Type Shallow Pressure Pretreatment Type >5ft. from foundation? --- -- --- - ---- -- ------- --- - - ❑ NIA VYES ❑ NO >50 ft. from wells? -- --- - - - - - - -- - - - ❑ ❑ ❑ Z >50 ft.from surface water? - - - - - - -�- - - - ❑ ❑ Z Cleanout between building and tank? - -- - -- --- - ❑ ❑� ❑ U Tank baffles present? -- - -- - - - - - - ��- - ❑ ❑ a 24' access risers over each compartme - - ❑ ❑ W Effluent filter installed?- - - -- - - - - - ❑ ❑ ❑ y Septic tank capacity (working) 12 a Manufacturer Hagerman G D-box water level and speed levelers used? ------ - -- - - - --- ❑ NIA ❑ YES NO QO Manifold/D-box accessible from surface?- -- --- --- --- -- - -- ❑ ® ❑ °PZ Check valves installed? -- - - - - -- - - -- - - - --- - - - --- - - ❑ ® ❑ oa 2 Transport Line Size 2- Schedule/Class 40 Bedrooms installed (check one) ❑ 2 JM 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 f. from foundalion?-- - - ---- -- - - - - - - -- - - - --- - . El N/A AYES ❑ NO >100 ft.from wells?- ---- ----- -- - -- -- - -- -- - -- --- - ❑ ❑ ❑ W >100 fL from surface water? -- -- -- --- - -- - - - - - - - - - -- - ❑ ❑� ❑ LL >10ft.from potable water lines?-- -- -- -- -- ---- - - -- -- -- ❑ ❑ Z > 5ft.from property lines and easements?- - - - - -- - - ---- - -- ❑ ❑ W > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - -- ❑ 0 ❑ in Drainfield level and observation ports present - - - - - --------- ❑ ❑ ❑ Graveless chambers or M Clean gravel used? (check one) Proper cover installed over drainfield?--- -- - - - --- - - - ----- ❑ ❑ Pump tank setbacks consistent with septic tank?----- -------- ❑ NIA YES ❑ No Y Pump tank capacity (flood) 1000 oal Manufacturer Ha erman Q24"access risers)and accessible from surface?-- -- - ------- - ❑ IN ❑ F d Alarm or Control Panel lnstalletl? -- -- -- - --- - - - -- - -- -- - ❑ Control Panel equipped with Timer/ETM/Counter- - - - - - - - - -- ❑ ❑ a Pump installed in E Bucket or ❑ On Block or ❑ Other d Pump Make/Model Liberty 280 ® Floats or ❑ Transducer D Tank draw down 2 in/min Pump capacity 38 gpro Squirt Height 4 ft Q. Pump on time 2.3 min Pump off lime 6 hr Daily flow set at 360 gpd uca.mae lwn Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENTRECORD ? - YES ■ NO Were existing septle components abandoned as part of this pro ea It yes, please desuibe: _______. NO Were all components pumped out and propedy abandoned per WAC246-272A-U30U YES RECORD DRAWINGand Ndine _ _ Tliube%tmanmtnaenN and mu4 MaccunY+ntl Gea[nptive etnou9laM1�mon.4W.enm+'.RXMdaidaid.even and P,Vaddi wYims,vlo liond adla. 'eWlinee. O�ewings CPnYal'. pro eld8mani(dd YlenYPm 6leyM,SepacggmP yM nlaYd Pian"a vd6,Wervaban Pa;Y,tl®nrub,and Marmeinmun¢aceu%inu. InmmpkY Re�'nd Omdngs mey ve[Y ad®tlornl delrys In final insYllatiM o%mvel 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 actor 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 cleamdrapproved by both the designer shown here have been ciearad/approved by bath 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 aD info ation contained on this I further certify that ail information contained on this form and a e Drawing is accurate. form and attached Record Drawing is accurate. (O-I-vf Signature of Installer Date Aj0.N� S h w sY= Printed Name of Signee ea MASON COUNTY PUBLIC HEALTH e The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public PAULA JOY JOHNSON'. VL v Health: 'Lfd E ioNEp Signature of Environmental Health Specialist Dana (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAIIABLE FOR PUBLIC VIEW ON THE MASON COUNTY w BSITE W<mw nrsirso�e Sralea"--5� � r :S 50 '15 ia0 0 (� 0MaS Ex[s+ing �``�� u�tAm 'fl,rtrnnC Pd rtiv ZP) a ` 3 NIp 287 l r APPROVED NOV 13 2024 - idASON COUNTY ENVIRONMENTAL HEALTH RET Audi Vw al Alarm o © Cleeaout 1200 GAUM,StPlic T ` ' Yx 2-Compartnent with Effiuent Fate PAIILA JOY JOMN '/y,� O lOOO Gallon PnmP Chamber 'L"w'f31JSE 1 510NEYt awaev '�-x«SS1S.dD OS Valve Control Box