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HomeMy WebLinkAboutswg2018-00393 - SWG Application / As-Built - 4/29/2025 CLEAR FORM • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 'Z D\ " Do 3 g 3 Parcel # 12305-21-00070 Applicant Name Stuart McMaster Subdivision (Name/Div/Block/Lot) Applicant Address 6096 Widgeon Ct City, State, Zip Bremerton, WA 98312 Installer Name Oien Construction Site Address 180 NE Tiger Lake Rd W. Belfair Designer Name Tom Weaver Allied Design Inc INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair 0 Other System Type Pump to Gravity Pretreatment Type Septic Tank >5 ft. from foundation? - - ❑ N/A ®YES ❑ NO >50 ft. from wells? - - 0 ® ❑ Z >50 ft. from surface water? - - 0 ® 0 HCleanout between building and tank? - - 0 © 0 U Tank baffles present? - - 0 ® 0 d24" access risers over each compartment?- - El II El W Effluent filter installed?- - ❑ In ❑ N Septic tank capacity (working) 1,200 gal Manufacturer Hagerman G D-box water level and speed levelers used? - - ❑ N/A it YES ❑ NO OOJ Manifold/D-box accessible from surface?- - 0 ® 0 DOZ Check valves installed? - - 0 0 III GQ 2 Transport Line Size 2 Schedule/Class Sch 40 Bedrooms installed (check one) ❑ 2 0 3 0 4 0 5 0 6 ❑Commercial/Other >10 ft. from foundation? - - 0 N/A ® YES ❑ NO C3 >100 ft. from wells? - - ❑ ® ❑ W >100 ft. from surface water? - - 0 II ti >10 ft. from potable water lines?- - ❑ ® ❑ > 5 ft. from property lines and easements?- - 0 NI ❑ 12 > 30 ft. from downgradient curtain/foundation drains? - - 0 ® 0 Drainfield level and observation ports present - - 0 IR 0 NE Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 MI 0 Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO Y Pump tank capacity (flood) 1.200 gal Manufacturer Hagerman Q 24" access riser(s) and accessible from surface?- - 0 ND ❑ H O. Alarm or Control Panel Installed? - - 0 0 El ❑ 2 Control Panel equipped with Timer/ETM / Counter- - ElElD a Pump installed in ❑ Bucket or It On Block or 0 Other a• Pump Make/Model Liberty 250 ® Floats or 0 Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Upda'ed 8/2112C18 Mason County OSS Installation Report pg. 2 Parcel# 12305-21-00071 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - D YES ❑� NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record Drawings contain Dramfietd&manifold onentatron&layout Septic/pump tank location.North arrow reserve drainfreld.existing and proposed buildings.location of wells.waterlines. wells observation ports cleanouts.and other maintenance access points Incomplete Record Drawings may create adddional delays in final installation approval and related permits 0 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 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of Installer Date Shae Olen Printed Name of Signee 4 MASON COUNTY PUBLIC HEALTH 1` t t The undersigned approves this Installation Report and 5100333 g PP P T OmAS ► E.WEAVER'.. Record Drawing on behalf of Mason County Public 'It 145E0' f NEfi" Health. (d(1\9_,M1 -5() 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 Updated 821/2018 v . + LA -- e MNLakeRdW -" VI \).1 +. I �* Ccll a) - P. 8° ..--- -....\L_ . 5 -: _ic-i-j." \\ Z.1 < AI vl • , -t., 5 i S 0 Ng g8 r- i. �, I N A w c a N o a w p I $ citi w p jt. i ^ n 3 O pw► 8 1.0 $ 3 a $ Q ° -g 9. N a pl 4 a a 3 `^ 3 g' a igM CI Do -- i $ 8 °'►. K' E c. a a 3 3 = a '- . = n. r ^' r ,:• I v, 2 3 ° 8 3 1 Ni 3 g 3 3 14i. • o I (1, ` I i cr/ ! 1 ' \ii 1 \ 71 I I" r7. ol ( 't) 1 0 — , > gr / / O o / I Q 0 T i (1/ I .•••''''..'"'....../ • /n\ f :.;°: 4.\\ IN sr to ,\zit I \\\ 0 •44 \\'. 3jr----4 :11‘‘‘ + �- \`\\\ ,v V1 • . Hu `v, —.i ` 1 0 n IV % i• �� • k. • 12305-21-00070 180 Tiger Lake R W 410— 1 -----;-"/ , 02 _ •. / 7, j 1" =40'