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HomeMy WebLinkAboutSWG2025-00316 - SWG As-Built - 9/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00316 Parcel# 122064201000 Applicant Name Wessner Harry C& Mildred E Subdivision (Name/Div/Block/Lot) Applicant Address 1383 Old Gardiner Rd City, State, Zip Sequim Wa.98382 Installer Name Shumaker Construction Site Address 470 E Rasor Rd Designer Name INSTALLATION CHECKLIST 0 Full System Installation 111 Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type gravity Pretreatment Type >5 ft.from foundation? - ❑ N/A ®YES ❑ NO >50 ft. from wells? - ❑ e ❑ Z >50 ft.from surface water? - ‘ 1� � ❑ ® ❑ • Cleanout between building and tank? - ���\ ® ❑ ✓ Tank baffles present? - _ _ _ ._�\'\1 _ _ ® 0 I:-- 24"access risers over each compartment: , - ta3— — — %- ® ❑ W Effluent filter installed?- k. _-� to tJ ''� ® ❑ Septic tank capacity(working) 1250 .al Map! -cturer Hagermen's D-box water level and speed levelers used? - - 1] N/A 0 YES ❑ NO OO Manifold/D-box accessible from surface?- - NI El QQCheck valves installed? - - ON ID ID a Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 23 ❑4 0 5 0 6 ❑Commercial/Other >10 ft.from foundation?- ® N/A ❑ YES ❑ NO C1 >100 ft.from wells?- - ® ❑ ❑ W >100 ft.from surface water? - - Ill 0 u.. >10 ft.from potable water lines?- - ® 0 0 Z > 5 ft.from property lines and easements? I 0 ❑ >30 ft.from downgradient curtain/foundation drains?- - MI 0 ❑ Drainfield level and observation ports present - - ® ❑ 0 ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ® 0 0 Pump tank setbacks consistent with septic tank? - - ON NIA ❑ YES ❑ NO Y Pump tank capacity(flood) gal Manufacturer Z < 24"access riser(s)and accessible from surface?- - ® 0 ❑ aAlarm or Control Panel Installed? - - 0 ❑ ❑ Control Panel equipped with Timer/ETM/Counter- - © 0 ❑ a Pump installed in ❑ Bucket or 0 On Block or ❑ Other n'• PumpMake/Model ❑ Floats or ID Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 821,2018 Mason County OSS Installation Report pg. 2 Parcel# 122064201000 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - If yes, please describe:Existing septic tank abandonded - (]■ YES NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - 0 YES 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: Dra'nfield&manifold orientation d layout,Septic/pump tank location,North avow,reserve drainfield,existing and proposed buildings,location of wells.watedines, wets.observation ports,deanouts and other maintenance access points. Incomplete Record Drawings may create additional delays in final,nstallatior.approval and related permits. 0 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 a/i 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 Record Drawing is accurate. form and attached Record Drawing is accurate. 5/24-/2c;2_5 Signature of Installer Date AMC-"A k4-tsiA Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: 9(fu-L Signature of Environm ntel Health 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 / / / 4<-" i �,44,.., fir, (/0 3t 44(1 nre-J tr / - 32. . i� ,, / 2 R1-sof CoMv,Y,k _ 1u44v Sys.,., A I !,0' p I v scR-1.e_ .fie. 470 E. 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