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HomeMy WebLinkAboutSWG2023-00397 - SWG As-Built - 7/31/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00397 Parcel # 12205-21-90072 Applicant Name Alexander Lincoln Subdivision (Name/Div/Block/Lot) Applicant Address 267 NE Tahuya River Dr LOT B OF SP#2900 AF#673150 PTN OF NE NW City, State, Zip Tahuya, WA 98588 Installer Name Shumaker Construction Site Address 460 NE ALder Creek Ln, Belfair Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST 1 Full System Installation El Tank(s)Only El Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - ❑ I ❑ >50 ft. from surface ewater? - - - - - EC �� - - ❑ El ❑ z CI Cleanout between building and tank? - - 30[- - -2Q-2S- -, ❑ ❑ V Tank baffles present? - ❑ El El I— 24" access risers over each compartm nt?- ❑ I CIa W Effluent filter installed?- y- - - ❑ ❑■ El cn Hagerman Septic tank capacity (working) 1,250 gal Manufacturer 9 CI D-box water level and speed levelers used? - - ❑ N/A El YES ■❑ NO J �O Manifold/D-box accessible from surface?- - ❑ ❑ El c92 Check valves installed? - - ❑ El ❑ CiQ 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation? - ❑ NIA Q YES ❑ NO O >100 ft. from wells?- ,',k-`'-k - - ❑ UI ❑ AePiPRC)iYi ❑ ❑ W >100 ft. from surface water?u. >10ft. frompotablewaterlines - - - . - - ❑ I ❑ > 5 ft. from property lines andnts. r-i ❑ Q i�1r11T9L1;ETs_ _ ❑ re > 30 ft. from downgradient curtll itirak r(ii�i ❑ al Drainfield level and observation ports present./ - ❑ © ❑ ❑ Graveless chambers or Q Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - El N/A El YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman z - CI 0 CI • 24' access riser(s) and accessible from surface?- t-- a Alarm or Control Panel Installed? - - ❑ I ❑E Control Panel equipped with Timer/ETM /Counter- - ❑ II ❑ D a Pump installed in 0 Bucket or ❑ On Block or ❑ Other a• Pump Make/Model Liberty 280 0 Floats or El Transducer n_ a Tank draw down 2.25 in/min Pump capacity 43 gpm Squirt Height 6 ft Pump on time 2 min Pump off time 6hr Daily flow set at 360 gpd Updated$121/2 'd Mason County OSS Installation Report pg. 2 Parcel# ( 2Z4 Q OOt7Z ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - E YES E 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- Typical Record Drawings contain: Grainfield&manifold orientation&layout.Septic/pump tank location.North arrow.reserve drairDteld,existing and proposed build rigs,location of wells.waterlines, wells,observation ports.cteanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. spa. PPROVE J U L 31 20?5 MASON COUNTY ENVIRONMENTAL HEALTH JBW • 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 and att ed Re :Drawing is accurate. form and attached Record Drawing is accurate. 1. G-4-'2'S Signature of Installer Date re;ti1 S ,'�ails—u< . � s Printed Name of Signee MASON COUNTY PUBLIC HEALTH L .• The undersigned approves this Installation Report and j 5100342 ; Record Drawing on behalf of Mason County Public } PAULA JOY JOHNSON '•. Health:. VC_ SUSiG�—YO . Signatf�re f,Environmental Heal Specialist Date (stamp, signature and date) L�.• THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8rz1/2318 6) NE,6 ?- WE'LL 1* ^ S F = iko r—30' 30, i / / _ 1 o Zo as vo /� c a �,; �t . A_EX SI NNG6LS r F / / / V,_ r z2v5-Z1-gooZ 2 M i9 o M;N 4100 N•E P.kc O�gC Lti TO 1) ". f l it ---- i \t \N rk _ /V. '1-5.1. . \ 7 iS\ - . 1 n. i ___ -- ' .-- \ -,s",. 1 7 i i tr‘o 1\7j -I o y r;YnaY�� I Kai pito•F b U Aoy\. Alarm *0S''V Cleanout • �� 00, / . e �6 P� � 3 1200 Gallon Septic Tank ��o/ / 2-Compartment with 5� �- :0 M/,✓ Effluent Filter \ -( r 04 V — J — ` 1000 Gallon Pump Chambe 9 T pow \ - f — -- I— brr-. NT o O Valve Control Box C' RS-N. . trn E-7- `V — — — I - — — — — — — —. r P EA)". — �/ 30' -EASE.`+ENT nY '0");•44,4 P-° APPROVER � �� a=''`�� r+�?'• 5,0�710 it Q; PAULA JOY JOMNSON I JUL 3 1 70I5 : ..., . :' . .mac-` Y ., , MASON COUNTY ENVIRONMENTAL kEAL'_ JBW 1vCce,-cs—