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HomeMy WebLinkAboutswg2021-00046 - SWG As-Built - 4/29/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00046 Parcel # 12305-21-00101 Applicant Name Morie Phinney Subdivision (Name/Div/Block/Lot) Applicant Address 5756 Eldorado PI NW City, State, Zip Bremerton, WA 98312 Installer Name Shumaker Construction Site Address 130 NE Tiger Lake Rd W, Belfair Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST © Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - 2 0❑ ❑ • >50 ft. from surface water? - ` � 4- ❑ 0 ❑ Z HCleanout between building and tank? - - -A A 5 - - - ❑ ❑ ❑ U Tank baffles present? - - - ❑ 0 ❑ H 24" access risers over each compartment - - - - - - - ❑ 0 ❑ a W Effluent filter installed?- 8/ - - ❑ 0 ❑ U) Septic tank capacity (working) 1,250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ElN/A ❑ YES El NO 00 Manifold/D-box accessible from surface?- - ❑ 0 El m 2 Check valves installed? - - - - 4-- - ❑ 0 ❑ al a 40 E Transport Line Size 2" Schedule/Class Bedrooms installed (check one) ❑ 2 ❑i 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO >100 ft. from wells?- - ❑ 0 ❑ o W >100 ft. from surface water?- - ❑ ❑■ ❑ ti >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ a ❑ ME ❑ � > 30 ft. from downgradient curtain/foundation drains? - - cl Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or ® 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 gal Manufacturer Hagerman Q24" access riser(s) and accessible from surface?- - ❑ I. ❑ a.▪ Alarm or Control Panel Installed? - - ❑ UI El a E Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ n n- Pump installed in 0 Bucket or ❑ On Block or ❑ Other a'• Pump Make/Model Liberty FL51 M 0 Floats or ❑ Transducer a • Tank draw down 1.75 in/min Pump capacity 33 gpm Squirt Height 7 ft Pump on time 2.7 min Pump off time 6 hr Daily flow set at 360 gpd Jpcated 8Y212018 Parse! Z3e S 2 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD YES ❑ No Were existing septic components abandoned as part V this nn If yes, please describe: '� i YES I_l NO pumped out and properly abanconed per WAC246-272A-030C? - Were all components RECORD DRAWING cal Record This is a permanent record and must oe accurate and descriptive lo�gon,Nor aRcocate in teese need of afield maintenance an�prospand osed buildings,Iota on of wre development ells,waterlines, D swings contain:ports. iC 3 man`nld other m on 3 layout.Sept cp p and related pennRs• wells,observa5on ports•dcan°�•and other mzin:eran=access points. Incomplete Record Drawings may create additional delaysin final installation approval 1- erss-) a Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER l certify that i installed the system in accordance with !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 I further certify that all information contained on this i further certify that all information contained on this form and att e iDrawing is accurate. form and attached Record Drawing is accurate. $•-(ta-2.* ' t Signature of installer Dare f-k - �C `% ot y4• Panted Name of Signee •• +f� MASON COUNTY PUBLIC HEALTH , � '.t l • The undersigned approves this Installation Report and sw.3is 5' ''�'� g-fj-li'A:::,Q;:k•.1PI:AuLA..;.Y4....1'..0- HNS.ON ' (1 Record Drawing on behalf of Mason County Public i_ri48: bSiGNrm" Health: 1 1.21/7,C— c�rx s i--A—wsb �,����IYY\� 4-( 6- vs- Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upeate°e2'rzdt8 Z any St-it ..0 \ _, ' o � 6 s o 5`- mac-;�, `p '� v �' / r p+ � Z30S"Z - Oo,of 1st i • i . 45 3 Sr'rj I, - [ --- HO A ,) _,, , s , .., , s I • . , C + 0 Z� 4,0 ,J Sa 0 ... c,„ .t ,.., ,..k. ____ _, ;, : ,... , 530 '-' • I w';w: ��,st', . 1 p 1 a.�'T^ - ry 1 O •IN _ r . ' �� A1IC1 V iSi12_? '' ; W L— ! 3 cieanout �. 3 a- _ :_ :\ { ,, _ _ 3 200 C,�:an Septc Te. 0 V ave Co_trol Box �� j� N-- ,� I ;' ..:43'k ' 1 • I ' P Al4 " \/'V\ 1 ( 1 - HN so d r kl•-bt........NP.AULA JOYOf i5100349 as ,^ ti Tx-- a - U�S :Gb i t E I t L. I i 1 RV\ --'" ---s\ 4. lL { AIDPRoVED ` I { 1 APR 29 2025 MASON COUNTY ENVIRONMENTAL HEALTH RET _. ,1 y_ • i t i c..., 1 '�Cait�1 a Sif� ... H i G+ i ,_____..3, t `, rIA 610\-1- ! j s . i 5 Patcrt#l2305'Z1-00i 0t - '— r3 130 Ne-TiG'r Lakt. a' , i '. • > t t S. « i `J _ Ito Zo 4-10 (00 f$ f Atk o. • . A,v) c4 "txt ___----)r. - Air, in -- . \:„ ,.•. , .... ... .;,:. ,,,. , • •._.x.„ `1 5100349 PAULA JOY JOHNSON �� 1 � 1 4s0 r I ' ...t. , - � � • ,..., .r, • ,l Q +; r i • 1 - t?I'- A' , .2 1 +a- 3_ _tee \ ( a M_ 1 a7 C} CSQa ! ✓!off' f f ✓ S _1 i - 4 It: i Fr; rinac 'J- " al - �nc�� ^ @ S o-� . A PP R O V E VV ��Y \ A {V � ' D . r�- ,r.•, �reser e- c.Y a-5. jPR 29 2025 4 P MASON COliNTY ENVIRONMENTAL HEALTH 0'zs 1 RET i