HomeMy WebLinkAboutSWG2023-00163 - SWG As-Built - 2/9/2025 Mason County OSS installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00163 Parcel# 323347500131
Applicant Name Joshua Heblich Subdivision (Name1Div/Blcck1Lot)
Applicant Address PO Box 706
City, State, Zip Belfair We 98528 Installer Name Shumaker Construction
Site Address 2706 Ne Dawatto Designer Name Advantage Pere&Design
INSTALLATION CHECKLIST
FUR System Insteliation ❑Tani Only ❑omxawtd only ❑paper, ❑Otha,
System Type Pump to Gravity Pretreatment Type
>5ft from foundation7 - ---- -- - - - - - - - - --- - - -- - - - -
- ❑WA AYES ❑ No
150ft.from walls? -------- - -------- ---------- - - ❑ ® ❑
Z >50ft.from surface water? -- - - - ------------
❑ ❑
Q Clesnout betwean building and tank? ------------ ------ - ❑ ■ ❑
V Tank baffles present? - - __ __ __ _ __ _ __ _ ___ _______ _- ❑ . ❑
1— 24"access users over each Compartment?- - - . - - - -_____. ❑ ❑
Q.
WW Effluent Bltermstalled?-__.- _ _._ _ _______ _ _ _ _ _ _ __ __ . ❑ ❑
Septic tank capacity(wording) 1250 aal Manufacturer Hagerman's
o D-box water Ieve1 and speed levelers used? - - - -----_____. ❑WA N YES ❑ No
000 Manifold,)-box accessible from sudace9-- -- - - ---------. ❑ ® ❑
mZ Check valves installed? - ---- -- --- --- ---- -- --- -- - -- - --------- - ❑ ❑
�4
f Transport Line Size 2' Schedublf:ims 40
Bedrooms installed(check me) ®2 ❑3 ❑4 ❑5 ❑6 ❑CommerciaUOlher
510 ft.from foundation? - - - - - - ------ ---- -------- - ❑ WA ■ YES NO
C >100ft.from wells'----- - --- ------------------ -- ❑ ❑
W >100 ft.from surface water?- - - --------------------- J ■ ❑
C >10 ft.from potable water fines?- - -- - - - - - - --- - -------- ❑ ❑
Z >5 R from r
Q popeny Gnes and easements? -- - - ---------- - ❑ ❑
M >30 ft.from dowrgradlent Curtainftoundation drains?-- -- -- -- -- ❑ ❑
Odurifleld level and of s ,ry hon ports present - - - - - - - - - - - - -- ❑ ❑
❑ Graveless chambers or.. ® Clean gravel used? (check One)
Proper cover installed over tyamfig(d?------------------ . ❑ ❑
Pump tank setbacks consistent with septic tank?----- - - - - - __ . ❑ WA E YES ❑ No
Y Pump tank capacity(aood) 1000 oat Manufacdurer Hagerman's
Z
4 24-access mulds)and accessible from surface?-- ---- - - - -- - - ❑ ❑
y Alarm or Control Panel Installed? -- - -- - -- -- - --------- - ❑ ® ❑
Control Panel equipped with Timer I ETM t Counter- - - - - - - - - - ❑ ❑
d Pump installed in M Bucket or ❑ On Block ar ❑ Other_
a Pump Make/Model liberty 280
$ Foals or ❑Transducer
d, Tank draw,down ,S r iNmin Pump capacity a pm pm Squid Height it�9 _a /!
Pump on time Pump o8 fare LA 1W,5 _ Daily flow set at l LI gpd
-roa,wa sa nia
Mason County OSS Installation Report pg. 2 Parcel s 323347500131
ABANDONMENTRECORD
Were existing SWIC components abandoned as part of this project? -- --- - -------- - YES ® No
"yes,please descdbe'.
Were all components pumped out and property abandoned par WAC246-272A-03007• --- - - 11 YES ❑ No
RECORD DRAWING
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® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that 1 installed the system in accordance with I certify that the system has been installed in aeper-
the septic design stamped"APPROVED'by Mason dance with the septle design stamped'APPROVED"by
County Public Health and that any de"dons shown Mason County Public Health and that any deviations
here have been cleamd/appmved by both the designer shown hem have been cleared/appromot by both
and Mason County Public Health and meat all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I fuNter certtty that all mliormffiion contained on this 1 further certify that all information contained on this
/Drat& Drawing is accurate form and allachad Recod Chewing is accurate.
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Sgrwhxa Inaleller Data
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Pn red Name or Sgnea
MASON COUNTY PUBLIC HEALTH A
The undarsigned appmves this Installation Report a IL
Record Drawing on behalf of Mara; � *Ihty P"
Hearth: `�CpNNryF 'fl�
spnewro of FsvlrtmmeNet Health specialist FN (staalp signature and dale)
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