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HomeMy WebLinkAboutswg2021-00657 - SWG As-Built - 5/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00657 Parcel # 322127600090 Applicant Name John Wieman Subdivision (Name/Div/Block/Lot) Applicant Address 106 Goldenrod St TR 8 & 9 OF SURVEY 2/134 NW1/4 DPC #23-13 AF#2 City, State, Zip Port Orchard, WA. 98366 Installer Name John Wieman Site Address 1060 NE Tahuya River Rd Designer Name Kevin Hughes INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pump, Pressure, DosingZoeller Pretreatment Type None >5 ft. from foundation? - -- ❑ N/A IN YES ❑ NO >50 ft. from wells? - ❑ UI ❑ >50 ft. from surface water? - _ ❑ UI ❑ Z • H Cleanout between building and tank? - - ❑ UI El 0 Tank baffles present? - __ ❑ ® ❑ d24"access risers over each compartment? - - El Ill ❑ � Effluent filter installed?- _ El II El Septic tank capacity(working) 1250 gal Manufacturer HAGERMAN PRECAST O D-box water level and speed levelers used? - ® N/A ❑ YES ❑ NO kO Manifold/D-box accessible from surface?• - ❑ III 0 CI Check valves installed? - - 0 II 0 2 Transport Line Size 2" Schedule/Class Sch 40 PVC Bedrooms installed (check one) 0 2 ❑3 Q 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A ® YES ❑ NO C >100 ft. from wells?- - ❑ I. 0 W >100 ft.from surface water? - El ill LL >10 ft. from potable water lines?- ❑ U 0 Z > 5 ft. from property lines and easements?- 0 El id El 30 ft. from downgradient curtain/foundation drains? - El ca Drainfield level and observation ports present - - 0 PE 0 0 Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ® 0 Pump tank setbacks consistent with septic tank? - - ❑ N/A it YES ❑ NO Y Pump tank capacity (flood) 1250 gal Manufacturer HAGERMAN PRECAST Z < 24"access riser(s)and accessible from surface?- - ❑ I® ❑ a Alarm or Control Panel Installed? - - 0 UI ❑ 2 Control Panel equipped with Timer/ETM /Counter- - 0 0 El n. Pump installed in ❑ Bucket or 5 On Block or ❑ Other 2 Pump Make/Model Zoeller/57 ® Floats or 0 Transducer d Tank draw down 1.25/1 in/min Pump capacity 30 gpm Squirt Height 2 ft Pump on time 2.75 minutes Pump off time 4 hours Daily flow set at 480 gpd Updated a 21/20018 V Septic.jpgti https://mail.google.com imail u ui Mason County OSS Installation Report pg. 2 Parcel# 322127600090 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 properly abandoned per WAC246-272A-0300? • YES El NO . • RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to relocate In the need of maintenance activities and future development i;FK;. Rc,.ord Crawrngs contain. Dra n!Ield d manHald orentaeon 8 layn r.SeptlUpump tare location.North arrow.reserve dra:nteld,enstng and proposed buildings.Iocabar of welts,waterlines, :..alas observation ports.deanou;s,and other nwurtenance access points. Incomplete Record Drawin gs may:roa1C addn,o.•W delays in final InstaflaGpn approval and misted perm.ts. IP 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 /further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. )// 2.5 n to Signature of Installer Date `,�Y Hun C It t LQ I.v. 0oF wasH�ti...y v.r� icv7 c,••t� ti-_ o:N Pnnted Name of Signt:•e ��a 1.s t CC MASON COUNTY PUBLIC HEALTH 45227 tt, The undersigned approves this Installation Report and : l'•.GiSTEQ' Record Drawing on behalf of Mason County Public Oi S..... S`-: Health: _IT\CLVYTOKI 62,o,s s4L Signature of Environrne I Health Specialist Date %i (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uparmd u2vinie 1 of I 5/12/2025, 11:56 Af ... x 0 0cn O 0 3 - cn u) - rn p �=D D o c O m c v SD m v) O p • CD p u,mm m c :r Occ < 10 < - 0 L3 v v 3 v m - cmmm cmO < ° m 0 D m m D - - m 0 - 0 mmI- 1- � miO a n /�� m Z cn cn 1 cn n m m v r r u = c D a D -t V co m O z n m m OD O -o z cO o Z z c m -4Z X m z* I- 0 zn A rn a O T m c cnO m - p -4 = m m � = X-0 - DA Z coW19 c H mxT D Z oO -I CO Dp-a -+m 00p � -ozm _ _m z o N)) o 0) o oo O m 0 Oz Z Z > = D N (1 03 cc0 W 0 ZA m ZZZ Oom � a) o OoA n O 0 Na c O ?o wd11 -4 ci) I _ D °) `° m W0 m Z m m o 7ao m o ' * cum -ci< my zncOm Nou, , > - Via = m i ) -riz - Z{1- OOnAD w� a H I- mN cr mO wWZ O v Co 3 O < m 0 m rn m, X O -I Z w A O07 ll< zm O, {< 1^ Z iy r o m co H D�O,/ N Z0 ` Z D 0 lj p urn cn Z 'l 33 m5 N O 3 0 Cin \ v g m ^' �-y� c r 1 1 n 1::".4*........ . (MI& �" F+ 'i. CD n N. a, !O 1 i a 3 3 N. P -v a `3 upco ,n..,., 3 2 3 �' (T Z Ida m -. cn o N 7 C D a O� A O N O 3 ixn r v I co v, C O Z d a v -I 0 H N m cr) m D m w m N N m n, 73 O � 'Zn CO -0 O N n xi CD m 71 D i.i m d Z O 3 ' Z O �� Nip �� 0 �'� - m 34, 6 , Z / d b m r 42� o • • Hy ©'. // \ 0 v` • • • m 0 0 i ���-- 11 • "' c m O- / /- • �� 1 -4, co-I z 1 / p' 1 1 Z m 1 / 1 1 1 =cn 1- I 1 1 I c m O m 0 1 1 ' Qom 11 1\� / l /1� o Z m F / * / ( / m 4Y rn-1� / F u \�\ // .3 JO p 5. xi mmn 0 0 O • . �. = �m a9y v ,iv1.fit+ o __. c r_ Designed By. KRH Scale. 1"=100' o Septic Record Drawing Drawn By: KRH Dale yvxs �D 3 •o �� ` kFi, N N Drawn d KRH N 3 N �� Ell ni P y59 i,i lrF,o/Z TEAM H U G H E S Mason County,WABy: d a, q 2 a,,i• i_ CI D o g 8 2•6 t- J ``* #� ENGINEERING Applicant: Site Address. o c,o > > 2 o r '^� \ _ g. 1060 NE Tahuya River Dr v o _u)o a a -P ? One&Dane Inc. S m F. m ,s°. �1c,Fo „•.1, (Michelle Wieman) Tahuya,WA 98588 -,m a'� / fR 4015 104th Ave SW (253)256-5486 (360)434-9112 Parcel#: 322127600090 Olympia.WA 98512 kevin@teamhugheseng.com