HomeMy WebLinkAboutSWG2025-00168 - SWG As-Built - 9/12/2025 (2) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2025-00168 Parcel # 322237500150
Applicant Name Evans ET UX Lonnnie Subdivision (Name/Div/Block/Lot)
Applicant Address 7426 NE 155th St
City, State, Zip Kenmore Wa. 98028 Installer Name Shumaker construction
Site Address 490 Ne Klahowya Rd Designer Name N/A
INSTALLATION CHECKLIST
❑ Full System Installation ®Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type gravity Pretreatment Type
>5 ft.from foundation? - - - ❑ N/A ®YES El NO
>50 ft. from wells? - mEcE1WE - ❑ i ❑
Y >50 ft. from surface water? - - ❑ ® ❑
H Cleanout between building and tank? - I -SEP-0-5- 20- - - ❑ I ❑
U Tank baffles present? - - - - - - ❑ ® ❑
d 24" access risers over each cornpartme tA- - - - ❑ MI
W Effluent filter installed?- - ❑ El ❑
U)
Septic tank capacity (working) 1000 gal Manufacturer Hagermens
o D-box water level and speed levelers used? - - NI N/A ❑ YES ❑ NO
DO Manifold/D-box accessible from surface?- - 0 ❑ ❑
0?-2 Check valves installed? - - . ❑ ❑
❑Q
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - 0 N/A ❑ YES ❑ NO
O >100 ft. from wells?- - 0 ❑ ❑
W >100 ft. from surface water? - - I II El
ti >10 ft. from potable water lines?- - MI ❑ ❑
Z
Q > 5 ft.from property lines and easements?- - 111 ❑ ❑
cc > 30 ft. from downgradient curtain/foundation drains? - - ® ❑ ❑
CI
Drainfield level and observation ports present - -- 11 ❑ ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ® 0 ❑
Pump tank setbacks consistent with septic tank? - - ® N/A ❑ YES ❑ NO
• Pump tank capacity (flood) gal Manufacturer
< 24" access riser(s)and accessible from surface?- - 0 ❑ ❑
H
a Alarm or Control Panel Installed? - - ❑ IN ❑
E Control Panel equipped with Timer/ ETM/Counter- - ❑ ❑ ❑
Q. Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a• Pump Make/Model LE 51 ® Floats or ❑ Transducer
Q.a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 8/21,2018
Mason County OSS Installation Report pg. 2 Parcel # 322237500150
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - El YES Q NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ■0 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: Drainfeld&manifold orientation&layout,Septic/pump lank location.North arrow,reserve drainfield.existing and proposed buildings,location of wells,waterlines.
wells,observation ports,cleanouls.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
It 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 at cord Drawing is accurate. form and attached Record Drawing is accurate.
s
Signature o Installer Date
tfivevi SILL(Nye✓
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
Signature of Environment 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
L O`t"c e Ft) '""S
\ EXISTING GRAVEL DRIVE ORIENT GABIN
® VIEW
- EXISTING DRAINFIELD AS CONFIRMED
4 RESERVE PER BY OWNERS /
511/G2 002-00445
250'GAL.PROPANE TAr
\ - R 0.r-1. - LOCATE PER OWNER
- N W 4 STANDARDS FOR
\ SIDENCE INSTALLATION OF
9 SF. PROPANE TANKS
COVERED
DECK 261 S.F. VERIFY LOCATION
I AND SIZE OF TANKS
\ WI OWNER
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LESO' SERIES IibePumps°
Sewage Pumps ,.......01"
A Family and Employee Owned Company
1/2 hp
2" Solids Handling
•
118 GPM at 10' TOH
25' Maximum Head •
Features . POWDER
_ - ' COATED
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• Heavy cast iron construction .. _ < TOv6M'
•Oil-filled,thermally protected motor
•Permanently lubricated ball bearings •
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•. j� •�r1¢
•2 Vane corrosion resistant engineered 't ( 3thermoplastic elastomer impe.ler Year Warranty
•All stainless-steel fasteners ano rotor shaft i
•Ouick-conrect i.0'standard power cord �" I
aLows replacement of cord in seconds -
without breaking seals to motor. _ .
(25'length optional.35'and SC'bare lead yi
cords available.) ;''
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Vertical float . ' ` '
switch models
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CERTIfIEDCUS
LE50-Series
Impeller Shaft
2 Vane semi-open capable of passing a 2" Stainless
spherical solid
Hardware
Paint Stainless
Powder coat
Mechanical Shaft Seal
Max Fluid Temperature Carbon
c
104°F(40°C)Continuous duty
140°F(60°C) Intermittent Bearings
Motor Upper and lower ball bearings "
Submersible type,oil-filled.hermetically sealed, Float Switch [automatic models]
thermally protected
Wide-angle and vertical float switch available
Power Cord Type
SJTW, Quick-connect 10'standard length
(25'corn option) Performance Curve
SJOOWV. bare:said 35'and 50'cords available
60 Hz,1725 RPM
Motor Housing Liters Per Minute
0 75.7 151.4 227.1 302.8 378.5 454.2 530.0 605.7
Class 25 cast iron 28 8.5
Volute 24 7.3
Class 25 cast iron zo - 6.1
16 4.9
Dimensional Data
x 12 - 3.7
Weight:I.E51M:42 lbs o
Height 14" 8 - 2.4
Major Width:11.5"{manual models) 4 12
0
0
20 40 60 SO 100 120 140 160
US Gallons Per Minute
All Models
MODELS HP VOLTS PHASE AMPS DISCHARGE SIZE AUTOMATIC IMPELLER
LE51M 1/2 US 1 12 2"FNPT No 2 Vane Semi-Open
LE51A• 1/2 115 1 12 2•'FNPT Wide-Angle Float Switch 2 Vane Semi-Open
LE51AV 1/2 115 1 12 2"FNPT Vertical Float Switch aVane Semi-Open
LES2M 1/2 208-230 1 6.8 2"FNPT No 2 Vane Semi-Open
LE52A' 1/2 208-230 1 6.8 2"FNPT Wide-Angle Float Switch 2 Vane Semi-Open
10 cona standard on above mnoes.
For 25'cord optio,.add a"-2's.,nr;n rondel t.,n:her.Example.LE.!1A-2
For S5'blrc nsd coeds on manila models•add a'-3'tzuf`ix.to model number.Exarrplt''LCs1h1-i
Fc,r 50'bete'eao cords u:rrauuo:!nodels,ado a"-5"suffix to model•u'noer.Example I151M-5
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Liberty Pumps-7000 Apple Tree Avenue-Bergen,New York 14416
Copy.r^;r, ica:y i i { .l J.J: A rights rese.eo.I Phone 800-543-2550-Fax 585-494-1839-www.LtbertyPumps.com
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DRAFTEDD BY: 1 OOO S, 1 000 S-T, I
P.O.BOX 3097 BATTLE GROUND.WA 98604 0 R.N. 1000 P & 1000 P-T
PHONE: (360) 687-7668 FAX: (360) 687-7669 SCALE: U7
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DATE
6/13/11
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