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HomeMy WebLinkAboutSWG2022-00237 - SWG As-Built - 9/16/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00237 Parcel # 42135-50-00040 Applicant Name David Lawrence Stevens Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 2626 CLEAR LAKE TRACTS PCL 27 City, State, Zip Belfair, WA 98528 Installer Name Jack Johnson Construction Site Address 641 W Clear Lake Dr, Shelton Designer Name Arrow Septic Deisgns, Inc. INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Sand-Lined Pressure Bed Pretreatment Type >5 ft. from foundation? - - - ❑ NIA ❑■ YES ❑ NO >50 ft. from wells? - ��( ..�� �s ❑ ❑ z >50 ft. from surface water? - -c-.N tf� � 1,, - _ _ ❑ El ❑ Q Cleanout between building and `�L �8�3- - - ❑ ■❑ ❑ UTank baffles present? - \,�;�- cj 1 - - ❑ 1 ❑ a 24' access risers over each comps ;ant?- - - - - - - - - - ❑ El ❑ W Effluent filter installed?- - - - - - - - ❑ I ❑ U) +� Septic tank capacity (working) 1 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A YES $ NO DO Manifold/D-box accessible from surface?- - Elx El cot Check valves installed? - a-A" T "N-Q`~"-Vc-- - ❑ E ❑ OQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) El 2 El 3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/other >10 ft. from foundation?- - ❑ N/A ❑ YES El NO CI >100 ft. from wells?- - ❑ ❑■ ❑ —) >100 ft. from surface water? - - ❑ 0 ❑ W L.T. >10 ft. from potable water lines?- - ❑ I ❑ Z > 5 ft. from property lines and easements?- - ❑ I ❑ Q El ® ❑ � > 30 ft. from downgradient curtain/foundation drains?- - • Drainfield level and observation ports present - - ❑ NE ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ NIA 0 YES ❑ NO • Pump tank capacity (flood) 1,250 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ ® ❑ F- a Alarm or Control Panel Installed? - - ❑ • ❑ 2 Control Panel equipped with Timer/ ETM i Counter- - ❑ © ❑ n a. Pump installed in 0 Bucket or ❑ On Block or ❑ Other d• Pump Make/Model Liberty FL102M2 ❑� Floats or ❑ Transducer a Tank draw down 2" in/min Pump capacity 46 gpm Squirt Height 5 ft Pump on time 2.6 min Pump off time 6 hr Daily flow set at 480 gpd ,;,^.cats..Si2'.2,,? • Parc& # 14 Z-1 — S.) — 0 0 `� Mason County OSS Installation Report pg. 2 �s 0 ABANDONMENT RECORD ❑ YES 0 NO Were existng septic components abandoned as part of this project? - - - - - - if yes, please describe - 0 YES ❑ NO Were all components pumped out and property 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. Typ.cal Recor6 Drawings contain. Orainfieta 8 mandokl orentalbn 8 1ayo.d.Septic'pump tank location,North arrow,reserve Jreinheid,existing and proposed battings.location of weds.waterlines. welts.observation pores.deanouts,and other me,ntenanc a access points. incomplete Record Drawings may:reate ada'horal oeleys in final tnstai,ation approval and re!atdd perm.is. S- R 111 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 fond a ed Record Drawing is accurate. form and attached Record Drawing is accurate. 9-8-25 r`tIISere of I taller Date .0.4 A434. Jack Johnson o*!�, IN Printed Name of Signee . ,,,...A MASON COUNTY PUBLIC HEALTH 4t4I F., l. The undersigned approves this Installation Report and '�, 510r349 Record Drawing on behalf of Mason County Public OnIONEtl- i. icT. P.AUTA JOY JOHNSON% N. Health: ` a i� QINAIVTC(Y1 9 j1ic 9—co-ts- Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB STE LOT i bo.._,3-4--.. s-r2ve/ns Far(fur- gv3s-so-000tto 1 )0x W i°a� , e D( SCaif . l v �C . ii I 0 -60 to q0 r" I\ 1 I ! E j . I 1 APPROVED 1 SEP 16 2025 MASON COUNTY ENVIRONMENTAL HEALTH I RET E l I i QO i (p \ , Ake J Ke s ' ` J J /77 Audio-visual Alarm Fr` 'ti1 ar 4 Sc in 1 i. ,J 0 3 Cleanout I:laC ~-d . i UV€ -11 f 2 S9 Y V t i -3- 2-Compartment \off `�` { 0 1200 Gallon tic Tank S i F` ' pw3t-h C I ow n. I Effluent Filter 1 4 1200 Callon Pump Chamber Ey� t I , ..„,„....,„ • I r-t1 _ mik . ,,..A.,...o,,,..,T. , 4 eeriL iv '1 i 1 ' f�-l•.• S1G0318 ' � .— PAULA JOY JOHNSON. ;� V� KQ 0okab:= S�• 1 'iGN • t \ 2 EXPIRES \'V Rr. co- LS