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HomeMy WebLinkAboutSWG2021-00005 - SWG As-Built - 8/25/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2021 00005 Parcel # 32234-50-00012 Applicant Name MATT& KAREN ESCHBACH Subdivision (Name/Div/Block/Lot) Applicant Address 12901 NORTH SHORE RD MADRONA MORNING SIDE TRACTS TR12 City, State, Zip BELFAIR WA 98528 Installer Name SHUMAKER CONST Site Address 12901 NORTH SHORE RD Designer Name MIKE JERKOVICH INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drai - • eil• ❑ Repair ❑Other System Type PRESSURE ��`��_,�`\ `\ etreatment Type ATU (BNR-500) >5 ft. from foundation? � - - �`- - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - ��w - - - ❑ U ❑ Y >50ft. from surface water? - - - - - V ��- - 1 - - '- I Z -�� : ❑ ❑ H Cleanout between building and tank? - - - ,-e - - - - ❑ III ❑ U Tank baffles present? - ,- - -�� - ❑ ® ❑ a24"access risers over each compartment? -0- - ❑ I ❑ W Effluent filter installed?- - ❑ ■❑ ❑ cn Septic tank capacity(working) 1000 gal Manufacturer TRASH 0 D-box water level and speed levelers used? - - 0 NSA ElYES El NO OO Manifold/D-box accessible from surface?- - ❑ ® ❑ 032 Check valves installed? - - ❑■ ❑ ❑ OQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 03 1114 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A ■❑ YES ❑ NO >100 ft. from wells?- - ❑ 0 ❑ ca W >100ft. from surface water? - - ;,'4 - ❑ ® ❑ u., >10 ft.from potable water lines. i -:t,�- V- s - s;:,� - - ❑ U ❑ � > 5 ft. from property lines and : ents'- '` - - ❑ © ❑ Q ,I C > 30 ft. from downgradient cu :Q in .undaHkd au`hs2i9 - - =�; - - ❑ U] ❑ Drainfield level and observatiofi't§gH i rltA /� T .''I - - - ❑ Al ❑ ❑ Graveless chambers or MI Clean gra ICJ?� -A‘&brie) Proper cover installed over drainfield?- `�'�� - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A • YES ❑ NO Pump tank capacity (flood) 1500 gal Manufacturer HAGERMAN Q24" access riser(s)and accessible from surface?- - ❑ El ❑ H a Alarm or Control Panel Installed? - - ❑ PI ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ PO ❑ m °- Pump installed in ® Bucket or ❑ On Block or ❑ Other a Pump Make/Model BERTY 280 EFF/LIBERTY LE50 SOLO ', Floats or ❑ Transducer 2 a Tank draw down 1.75 in/min Pump capacity 70 gpm Squirt Height 36 ft Pump on time 1.8 Pump off time 3.57 Daily flow set at 360 gpd Updated 8'21/2018 Mason County OSS Installation Report pg. 2 Parcel# 32234-50-00012 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES Q■ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES El 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: Drainfield 8 manifold orientation&layout.Septic/pump tank location,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 and related permits. APPOVE ,,,i,....t. AUG 2 5 ``I 2025 • MASON COUNTY ENVIRONMENTAL HEALTH JBW Iff 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 attached Drawing is accurate. form and attached Record Drawing is accurate. SZY 3vz! OP li ignature of/nstaJler ate 0 %��� '6'15 A. 04 Printed Name of Signee L' , i i 1._ x faZj MASON COUNTY PUBLIC HEALTH j' ' .�,r. The undersigned approves this Installation Report and `'' '&''' ' I, Record Drawing on behalf of Mason County Public I:a."MICHAELD.JERKOVICH �,tlt A LICENSED DESIGNER f1 8.5.25 Signa re of n r ental Heal Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 ' Zl000-oc-bfzzc T308ad n o '�i' .t t VM 'ald3 138 '38 380HS H19J0N 3N l06Z l ^*�` HJV9HJS3 N] VN aNd IIVN 1 w g t s - SZ 3 3-4R R9.�0 a i � a g s a Od =a - Y = 9iE - Igffigglafl zon� � §=.5%�W 5l-s Stn��� 1a! rn L�z3^� S3 I P� 44 'T 0 9;i425....5,E,,IgOe!"r8 . 4g1!-5m* ti .. ei ema � rv8 e- r ,1 . h p U d 12! a ig 44 iL o N aez :` Z szs bls2 1 134.81 5 [Iiit wk, , 0 ,..0 • 1 4 it , , 0 2 .: (NI rip c1` *k 1 \40 J 1 .� Ld ill 0 .., I •{ ',: , 0 V ' - IS{.{{• 1 X I I Pi- I M 0 80? g I-- w Ic S !S 5i 8 o _W w O DC a.4Aak APPRovE ;f OA A— n g t' �.N AUG 2 5 2025 : Y= ' MASON COUNTY �o � ENVIRONMENTAL AL I _ E" it HEA�TN 8 _, r„ ggg ;