HomeMy WebLinkAboutSWG2025-00116 - SWG As-Built - 5/7/2025 • CLEAZ FORM
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00116 Parcel # 12309-42-00161
Applicant Name Antonio Marcos Subdivision (Name/Div/Block/Lot) May 442
Applicant Address PO Box 3131 �f
City, State, Zip Belfair, WA 98528 Installer Name Aaron Schumaker �FCA-, ss
Site Address 3380 NE Old Belfair Hwy Designer Name Tom Weaver
INSTALLATION CHECKLIST
• Full System Installation El Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Gravity Beds Pretreatment Type Septic Tank
>5 ft. from foundation? - - ❑ N/A •YES ❑ NO
>50 ft. from wells? - - ❑ El ❑
Z >50 ft. from surface water? - - ElEl
HCleanout between building and tank? - - ElE ❑
U Tank baffles present? - - ❑ III El
O. 24"access risers over each compartment?- - ❑ IN ❑
W Effluent filter installed?- - ❑ NI ❑
N
• Septic tank capacity(working) 1,200 gal Manufacturer Hagerman
�0 D-box water level and speed levelers used? - - ❑ N/A III YES El NO
XO Manifold/D-box accessible from surface?- - El III El
mZ Check valves installed? - - El ❑ II
GQ
E Transport Line Size 4" Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 1113 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A i YES ❑ NO
>100 ft. from wells?- - --/"' S_O '76-0 0 t Si <i rsi - ❑ El IN
W >100 ft. from surface water? - - ❑ II CI
LL >10 ft. from potable water lines?- - ❑ ® El
Z > 5 ft. from property lines and easements?- - ❑ II
d > 30 ft. from downgradient curtain/foundation drains? - - ❑ NI El
cl
Drainfield level and observation ports present - - El II El
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ N ❑
Pump tank setbacks consistent with septic tank? - - El N/A ❑ YES ❑ NO
• Pump tank capacity (flood) gal Manufacturer
z ❑ El ❑
4( 24"access riser(s) and accessible from surface?- -
H
a Alarm or Control Panel Installed? - - ❑ ❑ El
E Control Panel equipped with Timer/ ETM/Counter- - ❑ El ❑
m
O Pump installed in El Bucket or ❑ On Block or ❑ Other
n'• Pump Make/Model ❑ Floats or ❑ Transducer
a.
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated erz12018
Mason County OSS Installation Report pg. 2 Parcel# 12309-42-00161
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES ■ NO
If yes, please describe:
Were all components pumped out and property abandoned per WAC24&-272A-0300? • - ❑ YES ❑ NO
RECORD DRAWING
This Is a permanent record and must be accurst*and descriptive enough to relocate In the need of maintenance activltles and future development. Typical Record
Drawings contain Dranfreld d manifold onentatian d layout Seplicipump tank location.North gnaw reserve drarfeld.earating and proposed buildings location or weer waterlines
welt,observation ports cleanouts and other maintenance access points Incomplete Record Drwrhgc may ueate additional deieys in final installation approve and related peones
111 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
I further certify that all information contained on this I further certify that all information contained on this
form a Drawing is accurate. form and attached Record Drawing is accurate.
9/214
1.
Signature of Installer Da
Aaron Schumaker 'y�X L ..
Printed Name of Signee _ , • s '
;
,,s� , . `..
MASON COUNTY PUBLIC HEALTH , .;' 4
I.
The undersigned approves this lnstallati Report and �� „�, v£.
Record Drawing on behalf of Mason Coun ublit,Z , ....-.. r ,"•1^E IA....
Health `
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7S...6 ct, <17.-',.. -- , .--- k
•
Signature of nvironmental Health Specialist Dei ' --� ` ' (stamp. signature and date)
C,. -
THIS FORM MAY BE SCANNED AND AVAILABLE FOIPUBLIC VIEW ON THE MASON COUNTY WEB SITE Lda•°d B'="r=='e
"1 = 20'
- C /A
evAN
NE 3380 Old Belfair Hwy
12309-42-00161 �9sLI, Af4 co& fro �1,
-§,-4,
%p �S
Powwer is overhead OJ9 oy�'Fti
Use three four hole D-Boxes or One eight hole D-Box 744
Install two gravity beds, 9' X 25 feet each with two feet of separation Fgey
Excavate beds 24" and remove any of old failed DF and backfill with C-33 sand to 24" T
Old 750 gallon septic tank may remain in place in series with new 1,200 gallon
NE Dusty Rd
SL#1 0-72" Loamy Med Sand
85't y Po eer
SL#2 0-72" Loamy Med Sand ," -•
Pockets of gravel ,
D/W I[Gravity Bed' ___,3.-\
L
_Grawity_ar—X-ST----X-Sci_i •2
Using Table X for 50' vertical1111
I
separation form well based on >36" , -- --_-
Horizonal separation 10.x 20'Deck i • c
-i"-60'Well it
�'"— '� Three Bedroom nf. Home
i.P.''01' Y o: 6 0 7 t,,,,Gallon
x 3
T
y' -H
5100333
�'THOMAS E.WF_AvER.• = O
UC NSEOOK$1GNE`-A�-..� ` TD
•CO
/ 4 / S' N I
'n 0 Shed I
O •
Drilled Well/ f-
CO
4 under Round steel cover N /N
46' //