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HomeMy WebLinkAboutSWG2021-00533 - SWG As-Built - 7/15/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00533 Parcel # 12019-50-00018 Applicant Name Teresa Hougland Subdivision (Name/Div/Block/Lot) Applicant Address 33 Valdarama Dr SMITH COVE DIV#1 LOT: 18 City, State, Zip Laguna Vista, TX 78578 Installer Name Shumaker Construe on AA,, Zt7 Site Address 200 E Smith Cove Way, Shelton Designer Name Arrow Septic Desi-,ns Incti/, / 7)C INSTALLATION CHECKLIST /kC /(i£O k Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair •Other 500-Gal Pre-Trash Tank System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A ❑� YES ❑ NO l'ICEWtp>50 ft. from wells ❑ I ❑ Z >50 ft. from surface water? - - ❑ 0 ❑ HCleanout between building and tank? - - - -NO-V- 2-024- - 2)- ❑ 0 ❑ ✓ Tank baffles present? - - - - - - ❑ El El d 24" access risers over each compartmer tBy_ 0 El- - - ❑ W Effluent filter installed?- a�� `— - ❑ ❑ 0 Septic tank capacity (working) BNR-500 gal Manufacturer Hagerman 9 D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO kO Manifold/D-box accessible from surface?- - - e �`�'`3' tK 'S - ❑ © ❑ mZ Check valves installed? - - ❑ 0 El 0< 2 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A Q YES ❑ NO O >100 ft. from wells?- - ❑ ❑� ❑ W >100 ft. from surface water? - - El 00 ti >10 ft. from potable water lines?- - ❑ UI ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ Q re > 30 ft. from downgradient curtain/foundation drains?- - - ❑ IR El Drainfield level and observation ports present - - El 0 El ❑ Gravelesc chambers or ❑ Cicon gravel wed? (check onc) Proper cover installed over drainfield?- - El 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A © YES ❑ No Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Q24" access riser(s) and accessible from surface?- - ❑ © e ❑ I` a Alarm or Control Panel Installed? - - Elil%.`? 0 2 Control Panel equipped with Timer/ ETM/Counter- - El 0 1\_Li‘ ❑ - Pump installed in ❑ Bucket or ❑ On Block or © Other flow inducer tube a' Pump Make/Model Orenco PF2005, 1/2 hp, 115v El Floats or El Transducer a Tank draw down 1.5" in 10 min in/min Pump capacity 2.85 gpm Squirt Height -- ft Pump on time 10.5 min Pump off time 1.84 hr Daily flow set at 360 gpd Updated 82//2018 Mason County OSS Installation Report pg. 2 Parcel# I Z 0 ono>,S ABANDONMENT RECORD NO Were existing septic components abandoned as part of this project? - E YES RI If yes, please describe: ❑ YES NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - 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 D ngs contain: Drainfi&d&manifold orientation&layout.Septic/Pump tank location,North arrow.reserve dra:nfield.existing and proposed buildings,location of wells,waterlines, well access observation ports,cleanouts,and other maintenance points. Incomplete Record Drawings may create additions!delays in foal installation approval and plated permits. 7Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER i certify that I installed the system in accordance with l 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 art e Drawing is accurate. form and attached Record Drawing is accurate. Signature of installer Date i r` n-**-A ••4- Pnnted Name of Signee 6.0,....t i`�MASON COUNTY PUBLIC HEALTHk. . - r �� '. The undersigned approves this Installation Report and sfe°+as '"� Record Drawing on behalf of Mason County Public PAULA JOY JCHNSCR' '. Health: Ult6iSI-I 0p► tip, EXPIRES , [ (�� t c— ?�-2`i Signature of EnviQ.n\Q-Ar1504q ental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updates arzt12o'8 C qs -Ter-es4 1-1 Oki cl ill , ti PGrCQf4r 201 0-5Y00018- a 1MO E 5-rh;t1, CovQ Way Sca/e:/"= f°1 o Z0 Lie 60 80 • . 4 . . . • r•r s,„..."•Jv„ g .C•,, NI 14 i' p2'l- .y Z 'x y285 ' PCB rnarL 1 ,�-r =� � ! Dp 46 s oLa1C'Oh. or _ M' v,�` „boy.5 `�`� _ �� Tc`G 0^ jtc+e �SZS �� p-E VO U, . ?.y+ (0" • Y . OAudio-Visual Alarm 3 4' g e ( C?eanout .* Z.51 ® 500 Gallon Pre-Trash Tank 0 NuWater BNR-500 Pretreatment Tani `� /30' 5 _,000 Gallon Pump Chamber - o - Spy cfiyj wO6 Subsurface Drip System Headworks c� �Y .. y-cPO52 • r Q. ��aT2� If APPROVE �;=• �.. ` JUL 15 2025 . .'.s MASON COUN7%,f.CNVIR .-f`� 510�348 ONMENtA1 HEALTH ••. PAULA JOY JOHNSO T\ RET efrS,+bf 'iGNE'�!'- lc —Z r-14