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HomeMy WebLinkAboutSWG2021-00048 - SWG As-Built - 4/1/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00048 Parcel # 12305-21-00102 Applicant Name Mark Churchman Subdivision (Name/Div/Block/Lot) Applicant Address 414 Kingsway NW City, State, Zip Bremerton, WA 98312 Installer Name Shumaker Construction Site Address 132 NE Tiger Lake Rd W, Belfair Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - -S 1 \ - ❑ 0 ❑ • >50 ft.from surface water? - � � ❑ 0 Z � '�CY - - ❑ 0 ❑ • Cleanout between building and tank? - �e U Tank baffles present? - \ - 0 - - - - - - - ❑ 0 ❑ 1: 24" access risers over each compartmen . .- - - - - ❑ 0 ❑ a ❑ W Effluent filter installed?- - - ❑ ❑ ell Septic tank capacity (working) 1 250 sal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES [1] NO J o 0 Manifold/D-box accessible from surface?- } _ - ❑ mZ Check valves installed? 0`4` - ❑ 0 ❑ OQ 2" Schedule/Class 40 E Transport Line Size Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑� YES ❑ NO O >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - ❑ 0 ❑ ti >10 ft. from potable water lines?- - ❑ 0 ❑ z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q ec > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑ a Drainfield level and observation ports present ❑ 0 ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1,000 qal Manufacturer Hagerman Q 24" access riser(s) and accessible from surface?- - Cl 0 ❑ H- a Alarm or Control Panel Installed? - - ❑ El • Control Panel equipped with Timer/ETM /Counter- - ❑ 0 ❑ n- Pump installed in 0 Bucket or ❑ On Block or ❑ Other a• Pump Make/Model Liberty FL51M ❑■ Floats or ❑ Transducer Q. a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 7 ft Pump on time 2.3 min Pump off time 6 hr Daily flow set at 360 gpd ;:crated 8,21201a Parcel - o ( -- Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD YES NO components abandoned as part of this project? - - - - - - Were existing septic comp ©4-` � (-sSro O cOoa If yes, please describe: ® YES [� NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - RECORD DRAWING This is a permanenttank location.North arrow.reserve crain5eid,ersdng and proposed buildings,location of wells,waterlines, record and must be accurate and descripti enough to re-locate in the need of maintenance activities and future development. Typical Record D.awdngs ervat n: Orts.old&manifoldt orientation&layout.access points. Septic/pump wells,observaJon ports,rleanouts,arc other mairterance a:cess pens. Incomplete Record D'awin9s may create addi5oral delays ir,final installation approval and related cents. cz fr.) I 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 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 cleared/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 Mason County Codes 1 further certify that all information contained on this I further certify that all information contained on this form and att e Drawing is accurate. . form and attached Record Drawing is accurate. Signature of Installer Cate A t .4a r� Printed Name of Signee s 4..,....." A. • MASON COUNTY PUBLIC HEALTH I • `il'r The undersigned approves this installation Report and �; soo:>.t� Record Drawing on behalf of Mason County Public yam' PAUTA JOHNSON � UC LA JOY• ES3�iv�'ft Health: s� e/Navyk �/1 )ZA �c (0 S Signature of Environm ntai Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WE3 SITE wdasee 812t2o:a "fa,r\K S i-TG -.0 . o C __�y_�' �: s 1 s AS _- - Q N110,ft Gil VcGhPr'aN\ a� Z q l 5scel -lz305-Z(- oor o 2. -- 3 I ‹. SCOtlf : le::H° ._ f „) . , l'A. i A Z s -/- s J v I • O 0 20 ya (0° 90 115 i ,i% 0 0 i'c'el____. 1 1 0- C``. .- 3 I / \ii? • ` \ / ' r1W-S;i. '- --t'r,,^ma, 1 o►L1 (2) Audio-Visual Alarm' _ Qllt ». \ I I 3 e ` �µ.. \ . i —- — \ — i 3 1200 C-2tlon Septic"i'2 ' .<' .�M tTJ I I /�\ ' ' 2-Comartnent with i \ I Effluent Filter ' z 1<. ;p '; I r , O 1000 Croon,p C. f tr ; I I1; 3 Valve Control Box -' io A o •.<' ). ,. -,,_.. .\ 1 .• 1 51 D0349 •S‘s,t �� 1 l'a�. PAULA JOY JOHNSON •. l ,�0vs'` nicr,fa• < ( rs,.. j i ( I ion Is : 1 1 s s v) ) � Ro aP V�D -74y\ � MA R ?9 I il, NCOU,y�yFh ?D75 i/ S REr f NrAL y��tH \ `J I • __. /1 1 • \,/ ii T /.. . ,..., ,. pccit-knc,-eA si±c, „,, _ -1-- 0 ! 1`75 ,...: >1 L' ,i- + I Mack Ckurck v: M k . -,..,-, sue. ' ` ? rcrli�i-112305-2i-OC!OZ �- , t !sv ihI ,‘ �� ale i , % o 2 p H O (of) SO I �, • A T1:: - i2 ,. o.,•rA aH�k,- .1:: rl,• -.:,,,,„ -- . ...,:-_, __________*____. :;...(2 .----•--)1. . , • T1 jr) YlP,' .S '?'.r�\ Yt' PAULA JOY JOHNSON ��1` . 1\ i Q ° I EXPfRE T305/'"• 'SVti,D Q y + + ' o t- A R 2 9 ( t � A �� i MASON couN 2025 N- I EN'4RpNM • RET TAL HEALTH _mod j a � I >. o a 5 = . 6 r • <� c M 4' , (L) 3x50_1 } o (; vharU ; _F • -lip n c x @ 5 ` o_r . \ 'Xt ! Grp f a,.•, f Y-eser�e. c,Yc,f.ts ,0 es 1