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HomeMy WebLinkAboutswg2025-00393 - SWG As-Built - 11/25/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00393 Parcel# 419273300010 Applicant Name Charbonneau Alexis Subdivision (Name/Div/Block/Lot) Applicant Address PO box 515 City, State, Zip Union Wa. 98592 Installer Name Shumaker Construction Site Address 4466 W State Route 108 Designer Name N/A INSTALLATION CHECKLIST ❑ Full System Installation I.Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Add septic tank with solids pump Pretreatment Type — >5 ft.from foundation? - -- �{I - ❑ N/A ®YES 0 NO >50 ft.from wells? - �J - ❑ I 0 • >50 ft.from surface water? -- -- - , - 0 ® ❑ Z �025 -- hQ- Cleanout between building and tank? - \ -0-2�- - ❑ ® ❑ U Tank baffles present? - -- - - - ❑ Li 0 d 24"access risers over each compartm:nt?- - - - - - - ❑ ® CI W Effluent filter installed?- BY - - 0 ❑ MI Septic tank capacity(working) 1000 gal Manufacturer Hagermen's 9 D-box water level and speed levelers used? - - © N/A ❑YES ❑ NO 00 Manifold/D-box accessible from surface?- - X ❑ 0 u. mZ Check valves installed? - - ❑ ® 0 0Q 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 0 2 0 3 ❑■ 4 0 5 0 6 ❑Commercial/Other >10 ft.from foundation?- - ® NIA ❑ YES ❑ NO C >100 ft.from wells?- - ® 0 ❑ ..6. >100 ft.from surface water? - - I 0 0 u., >10 ft.from potable water lines?- - IN 0 0 Z > 5 ft.from property lines and easements?- - 0 0 ElC > 30 ft.from downgradient curtain/foundation drains?- - PE El CI Drainfield level and observation ports present - - PE ❑ ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - II 0 ❑ Pump tank setbacks consistent with septic tank? - - 0 N/A ❑ YES ❑ NO • Pump tank capacity(flood) gal Manufacturer < 24"access riser(s)and accessible from surface?- - ® 0 ❑ F-a Alarm or Control Panel Installed? - - El UI 0 2 Control Panel equipped with Timer/ETM/Counter- - UI ❑ ❑ M d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 2 Pump Make/Model LE 50 III Floats or ❑ Transducer a, 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# 419273300010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES Q NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 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&manifold orientation&layout,Septicipump 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. 0 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 Record Dr is accurate. form and attached Record Drawing is accurate. / /Z /Zvi ' nature of Installer Date �¢J)✓( JY l 14 Gb4 ✓- Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: K—jtr )7V1(rsiltil I (Z0Z-5— 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 SITE Updated 82112018 CC m „ > > �+ „- rr O s0 00 V °t u, - Ls) NJ 1-,, (1) WN T N N n D 'p C < (p (vp+ ry� T Cr rs• 7 0 3 Vf C 7 t CDft, 3 C a Cu O O `��` d < < G a Q Q a v _ ° 'm o, - v m -0 7 a atr' r, 0 in ° c ry Fir,t 0.3 a u, Q.c x D D m ry O 7 7 p T vi 0. c, = 7 fD oi m F,- n = cr,- -, 3 3 -n -n - a a co .- m ? a z it , rD . . o • ° S R K rt m n * µ fop (gyp`O N N O'• 0 W y W - ,ND d d fD fJ (D C N O -G < -^x� O 0O °0`� N W F "' 3 3 `T U vNi CO sn o 0 Q3d of in C r, 33 v' m -, a, o H U1IIUa ry 7•D D w a R i � \ ^ • N N n v(pp _' \ f0 7cp CD f7J X = R \ O r N CO C r _ ...•, 4 S,t r N O W D0 Dp ,, i •1 0 w O - K3 14 < %t .. . . :,.1o.1 7, w a• w. 1 w �,�,,: • • ., • I fAiit' tars. i 1 W . j :. NI t ', e , : 'e`er: AI::'i* - ►'�, y 1 , ;,\ , , t- 4.••F^^, ‘4:". •,, • 11 � `r-tl ♦1a Mom--- 3 N. -00010 . 111(t.",,, t 47927-32-00030 ?. t t It, \ `4��.`A F' • t LL - ,i a s .� "'hhh '�Gt ` i 7 . }. \ i • • _ _ Q a r .. m 0 s. _ 70 cu Site Environmental:' * PFOVa,D'' -- o ro Map OCT ()15 o s C Cr cr Parcel#41927-33-00010 P8:SON COUNTY 4ZO1i ENf t.HITti oz� o 41927 32-00030 gZ'` A s �z II. ' N X 4466 W State Route 108 n -. o fl c _ °i Ni 0- Shelton,WA 98584 a o r N NAz " rt.o Di 3 I LE5O-SERIES therlipumps.Sewage Pumps A Family and Employee Owned Company 1/2 hp 2" Solids Handling 118 GPM at 10' TOH 25' Maximum Head + Features • r "" _ POWDER r-- — -� COATED •Heavy cast iron construction `' TOUGH" •Oil-filled,thermally protected motor e •Pen-nanently lubricated ball bearings - .-_ - i3) •2 Vane corrosion resistant engineered / thermoplastic elastomer impe.ler r Year Warranty •AR stainless-steel fasteners and rotor shaft ._ 1 i NSW •Quick-connect 10'standard power cord allows replacement of cord in seconds `! < " V. • without breaking seals to motor. . (25'length optional.35'and 50'bare lead .ia ., cords available.) • • It t , ,. : 1'',-.___‘ Vertical float APPROVED switch models I available in 115V OCT 03 2025 y.L. -. MASON COUNTY ENVIRONMENTAL HEALTH i RET 1 1 sP a. . 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 ceramic 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'cord option) Performance Curve SJOOW, bare lead 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 1.2 Class 25 cast iron 20 6.1 c 16 4.9 Dimensional Data A 12 - 3.7 Weight LE51M:42 lbs o 0 Height:14" 8 za Major Width:11.5`(manual models) 4 1.2 0 0 20 40 60 80 100 120 140 160 US Gallons Per Minute All Models MODELS HP VOLTS PHASE AMPS DISCHARGE SIZE AUTOMATIC IMPELLER _ LE51M 1/2 115 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 2 Vane Semi-Open LE52M 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 fl`batS ja 9'SLli Oyen 10'cord standard on above models. ' i \♦ t� For 25'cord option,add a'-2'suffix;o model rumber.Example:LES1A-2 OCT 03 2025 For 35'bare lead cords on manual models,add a'-3"suffix to model number.Example'LE51M-3 For 50'bare lead cords on rranual models.add a'-5"suffiu to model number.Example:LE51M-lr1ASON COUNTY ENVIRONMENTAL HEALTH • 59eu,ItiS SSUO:t. c Now earnciut Liberty Pumps-7000 Apple Tree Aven;.,_ Nc, r(DIK14' CopYri9nt®UcersY Pumps,Inc.2021 A.:rights reser.ea.tLIT00t500-R12/21 Phone 800-543-2550-Fax 585-494-18 3 .......'_ibertyPumpi.com n r a pCC7 G _ 't. M'i ,. ,r. f'lf f7 R�.a,: Swui::k ]�} 7Qi r T , . .17s, o :�, sl y :S9. ..6 'r `.d 1 !q.! , • gNI* e, e 4 70 t:.7,_1-• &.• s �-, SrFi 1�as �r t .„ .:.�, { \ 4. J 7 ,. .:60r z 35 a t; r-3 , N • .o {sI.., .0;'ti C` — L, .;ur ,i; * HI1b3H 1V1N3WNONIAN3 AINn03 NOSVW ;:.%. ' :,- , III .3Ati4aav i. r•• 1 • ;,r 7.1,3: •:.1 1 1 , rJ�,,r lj,. :.i• 3-•,ns3 = .� �1re :fS I �' "s< •�.,,c •_.v.fi�' Ij }^ •-t' 16 r at ~r` III " w 4 • .; y• c L a !;: ...i. 6. Jit a r• - tI.• / a` 47 4. EK ENGINEERING INC. DATE: 6113f11 T Pi(ruktsccavales ; DRAFTED BY: 1000 S, 1000 S-T, m P.O.BOX 3097 BATTLE GROUND,WA 98604 D.R.N. 1000 P&1000 P-T PHONE: (3601 687-7668 FAX: (3601 687-7669 SCALE: NTS )AGERN N PRE-CAST H11Y H i 1N3ItiNO AN31UN1100 NOSY czaz E p no 1 ,3� Nvrt 3 Qt` , Sl N a.o OS s� �M ONf10 O 3111b9 L'U£X09 O dd ii-S 000 L is o00 A9 a3 t�vao a (asy�i.Y),,,.,:9.•i�ivJ.JS\,.Ylr:i:CJA'.al L L/C ll9 •3. „0 '3NI ONI d NIOND NB "c__ , ' - ' 1 - I is . i! ::I:. ! I � r ti r f .......1 •a4 ', .1 1 i j t 1. t 111116. xv,..,.... d:9.9. 1 - aT h_�aR• a•L! � P. } _ I;i %t S I r- .. :.:, j), - -a .� 1 ! 1 l , �, � _ of a n �.r' d