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HomeMy WebLinkAboutSWG2025-00310 - SWG As-Built - 10/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00310 Parcel # 222012300001 rbICOMEN)EtrN Applicant Name Webber Elizabeth Subdivision (Name/Div/Block/Lot SEP 2 9 2025 '� Applicant Address 101 NE Lynwood Dr ,„ City, State, Zip Belfair Wa 98528 Installer Name Aaron ShumakBYY Site Address 101 Ne Lynnwood Dr Designer Name N/A INSTALLATION CHECKLIST 0 Full System Installation ®Tank(s)Only 0 Drainfield Only ❑ Repair ❑Other System Type gravity etreatment Type >5 ft. from foundation? - - EN/A NI YES ❑ No 0 ❑ Z >50 ft. from surface water? - - - - - ��Sk..),/ - �O�st, itIC Cleanout between building and tank? - - �P �� I.� ❑ ® ❑ Tank baffles present? - c 5 - ❑ ® ❑ d 24"access risers over each compartment. - - -- ❑ t ❑ W Effluent filter installed?- - - 0 NI ❑ N Septic tank capacity (working) 1000 gal Manufacturer Hagermens O D-box water level and speed levelers used? - - MI N/A ❑ YES ❑ NO oOJ Manifold/D-box accessible from surface?- - 0 ❑ ❑ CO Check valves installed? - - 0 ❑ ❑ OQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 0 2 0 3 ❑4 0 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? - - II ❑ ❑ IT >10 ft. from potable water lines?- - NI ❑ ❑ Z > 5 ft. from property lines and easements?- - 0 ❑ ❑ a Ill El El > 30 ft. from downgradient curtain/foundation drains? - - 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? - - Q N/A ❑ YES ❑ NO • Pump tank capacity (flood) gal Manufacturer < 24" access riser(s) and accessible from surface?- - ® 0 ❑ ~ a Alarm or Control Panel Installed? - - Ill ❑ ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - 0 ❑ ❑ M i1 Pump installed in 0 Bucket or ❑ On Block or ❑ Other n'• Pump Make/Model 0 Floats or ❑ 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 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # 222012300001 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES El NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 11 YES Ei 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&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. 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 cord Drawing is accurate. form and attached Record Drawing is accurate. 3 20Z$ Signature of Installer Date /14t/v.1 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 Environmental ealth 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 A/E L 1NNl4JOO/J JOiC, QJ qo FEET 5 � rN)015 of pkGE 4NA I Ex15TtwC� Po riA-e T t (000 k\ N•""• 1 11 rA PPR® L2 !,6,_ This site map was created by MCPH by coordinating measurements and information O O 7 2n,5 from several sources. including the Mason U n County GIS and a field review. 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