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HomeMy WebLinkAboutSWG2023-0405 - SWG As-Built - 6/25/2025 0 1 t Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2023-00405 Parcel # 32006-50-06007 Applicant Name Jeff& Debi Carey Subdivision (Name/Div/Block/Lot) Applicant Address 75 E Island Lake Dr ISLAND LAKE SHORELANDS BLK: 6 LOT: 7 City; State. Zip Shelton, WA 98584 Installer Name Shumaker Constuction Site Address 72 E Island Lake Dr, Shelton Designer Name Arrow Deptic Designs, Inc INSTALLATION CHECKLIST © Full System Installation ❑Tank(s) Only 0 Drainfield Only ❑ Re•air ❑ Other System Type Sand-Lined Pressure Beds 1..-:IV nt Type >5 ft. from foundation? - � ! l` 1\1 N/A Q YES ❑ No >50 ft. from wells? - T_,, k., _ l di I ❑ _ _ 1015 _ � � z >50 ft.from surface water? - _,�� ■ I 0 Q Cleanout between building and tank? - - - - - - ❑ . 0 1!— U 0 U Tank baffles present? - d24" access risers over each compartment?- - - Bi- - - - - - - - 0 El 0 W Effluent filter installed?- - 0 0 0 U) Septic tank capacity (working) 1,500 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑■ NO oO Manifold/D-box accessible from surface?- - ❑ II mZ Check valves installed? - - -P2''-"'\ " - 0 CI 0 04 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) 0 2 E 3 0 4 0 5 ❑6 ❑Commercial/'Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO CI >100 ft. from wells?- - ❑ CI 0 w ❑ ❑ >100 ft. from surface water? - - ❑ ti >10 ft. from potable water lines?- - ❑ 0 ❑ � > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ Q c > 30 ft. from downgradient curtain/foundation drains? - - ❑ A ❑ o Drainfield level and observation ports present - - ❑ It ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A Q YES ❑ NO Pump tank capacity (flood) 1,500 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ 0 ❑ I` a Alarm or Control Panel Installed? - - ❑ © ❑ 2 Control Panel equipped with Timer/ETM /Counter- - ❑ I ❑ n a_ Pump installed in ❑ Bucket or 0 On Block or ❑ Other a. Pump Make/Model Liberty FL100 0 Floats or ❑ Transducer a- a Tank draw down 4 in/min Pump capacity 104 gpm Squirt Height 5.5 ft Pump on time 1.4 minutes Pump off time 6 hours Daily flow set at 600 gpd ,,,,date tl 8 2"2C 1 Mason County OSS Installation Report pg. 2 Parcel# 3200E— s- c' &)1 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - CI YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-C300? - - ❑ 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: Grainfield 8 manifold orientation&layout.Sepdclpump tank locaton,North arrow.reserve drainfield.existing and proposed buildings,location of wells,waterlines, wells,observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval ant related permits. ', 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 I further certify that all information contained on this 1 further certify that all information contained on this form and att t Re Drawing is accurate. form and attached Record Drawing is accurate. t\ Osf l6125 Signature of Installer Date ,A). .„ .., , Printed Name of Signee ��^ ,, t n MASON COUNTY PUBLIC HEALTH I401 ;1 i The undersigned approves this Install,��n Repot VI •IV �+, } 1X �+�' 4,a 510034g '-V.. Record Drawing n behalf of Mason Coiiiq?-Public"',� �-t PAUI_A JOY JOHfi SON Health: '`-,.. ?ea ,`' d- ,3 8.M.:t:Sr 6 ZSd EXPIRES �S,`�O ? rS Jig v '�r q ,, -,g-Zs Signature of E ironmental Health Specialist Date Z k (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY+NEB SITE upeatec 8212018 , . i• • . t;c) PC j . g..-D-Esi (Niy I I II \ • TAczcsiA2F-3100 -50 -0 c,,,cl- 1 v I i A 2. K9p, 1 , \ , Gartt9e- ( \ I I , ki I I 1 (1) 5f`Bilk /1 ..._ v1,64 --Uv,S). I \ I . top . 4-o / —pi ,-- ....._ —...1 : 1 . kstAk k_114 it 1 gDP . , • / I 1 .----1 / 1 / I I tri 44p" 1 b.) J0/ Prc47 d *4454, 25 . 1,Resi• e if •„. (.004/)., • Pk- ir e4 *a / l' ' 0,/,'` ,.;•.,- ( ' see ', - A.,"reA11111100K ,_ : .-.•,: \N'tikk' 1 •, ,.,•/. ta mmtm•,+.mime.imeramiow 1 V INS 0 k ISSM D r i l e t it 0 0 tr.rit c .f) • r".1 . Audio-Visual Alarm 1 1 • . c \ • ..;3 Cleanout 7 3 1500 Gallon. Septc Tack — -- — \i 2-Conapartment with Effluent Filter 1- -7 7 24 7 — — — --' (.-2. 1500 Gallon Pump Chamber .L I mcitx,etv _ clap. -'r .17- 'r . I 7.; 0/4........-Vb + ‘.. .xsis I. "-62-rt,\*I.1-Et•j• ..-t. ,t•, t". . ,,.•five, • . . + FROPG5.'571,----NJrz ..,.._A:....... : ,.; , .:.-,,,i.:-.•• 5 1 C,C 34 9 . ..--ci`b 1214-..ctl ' ,'-i,c,F. PAULA JOY JOHNSON ..k\ -:__,\__, ..4-0i:Afr"_t•;:r.11.4tlf:' -S\- fiXFIC3F--S l& — E. 'tSLI.,13-7 L-N(4.--- -_,:-..s.c.,--