HomeMy WebLinkAboutSWG2025-00024 - SWG As-Built - 5/12/2025 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00024 Parcel # 22108-52-00071
Applicant Name James& Edirae Thatcher Subdivision (Name/Div/Block/Lot)
Applicant Address 40 NE Tiger Cove Ln PARADISE SHORE ESTATES, TR 71
City, State, Zip Belfair, WA 98528 Installer Name Shumaker Construction
Site Address 331 E Lakeview Dr., Grapeview Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
• Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type Shallow Pressure An ' :treatment Type
>5 ft. from foundation? - - �V� - - ❑ N/A ■❑ YES ❑ NO
>50 ft. from wells? - � � VVV _ ❑ U ❑
er? - r4 - - - ❑ I ❑
>50 ft. from surface wat
z -��`� 1� ❑ 0 ❑
HCleanout between building and tank? - -U Tank baffles present? - lip- ❑ El ❑
r- 24" access risers over each compartmen ? i� - ❑ X ❑
W Effluent filter installed?- - - ❑ I ❑
co
Hagerman
Septic tank capacity (working) 1,000 gal Manufacturer Ha 9
CID-box water level and speed levelers used? - - El N/ANO YES ■
J II ❑
�O Manifold�`D-box accessible from surface?- - ❑
a?-2 Check valves installed? - ❑ ❑ 0
❑a 2" Schedule/Class 40
2 Transport Line Size
Bedrooms installed (check one) I 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial'Other
>10 ft. from foundation?- 2- V"-k`A-- - - ciO r- - ❑ N/A ❑ YES 0 NO
• >100 ft. from wells?- - ❑ I ❑
>100 ft. from surface water? - - ❑ 0 ❑
W El ❑
LL >10 ft. from potable water lines?- - ❑
z > ft. from property lines and easements?- - ❑ 0 ❑
re 5> 30 ft. from downgradient curtain/foundation drains? - - ❑ • ❑
❑ II ❑
Drainfield level and observation ports present - ❑
❑ Graveless chambers or 0 Clean gravel used? {check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A El2 YES ❑ NO
• Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman
z \�'
< 24" access riser(s) and accessible from surface?- W` ate ❑
H Alarm or Control Panel Installed? - - - -
a - ❑ rt;svlezA‘li
5 Control Panel equipped with Timer/ETM /Counter- ❑
❑ ��
n- Pump installed in 0 Bucket or ❑ On Block or ❑ Other
n- Pump Make/Model Liberty 280 ■❑ Floats or ❑ Transducer
0.
a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 8' ft
Pump on time 1.5 min Pump off time 6 hr Daily flow set at 240 gpd
Updated 6 21/2018
Parcel# 221085200071
Mason County OSS Installation Report pg. 2
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? • - ❑ YES NO
If yes, please describe: ❑
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 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 cc:taint Drainfield&manifold orientation Si;ayeut,Sepn;ipump tank location.North arrow,reserve dranfie'd.existing and proposed buildings.location of walls.waterlines
wells,observation ports.cicanouts,and other maintenance access points. Incomplete Record Drawings may create aeddiortal delays in final insallaton approval and related permits.
V --
11 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
1 further certify that all information contained on this 1 further certify that all information contained on this
form and attached rd Drawing is accurate. form and attached Record Drawing is accurate.
14 -Za,-2-S-
Signature of installer Date orthf
Pr6k, Y S ti.A. jN' — ••••
Printed Name of Signee ,(
of .
MASON COUNTY PUBLIC HEALTH . itrt�)••
The undersigned approves this Installation Report and - ?' C, •L• !
r," t o349 t.
Record Drawing on behalf of Mason County Public y ��k
PAUCA J^vY Jctit.i CN r
Health: .( L1CI U4401�j'ri+;t:Ea•'
liQtr-Awlyvpcoll (( i13I?S — �EXPI � s
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 lipcated 8,'2 f 2cte
71
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C. 1000 Gallon Septic Tank
\-" 2-Corapartnient with
4Euen_t Filter
t o` pR>v>rwq .. ,1I 1, O 1000 Gallon ump Chamber
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- O Valve Control Box
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APPROVED .•�� . b,
NOV 1 3 2025 «►n '
MASON COUNTY ENVIRONMENTAL HEALTH ,'
s� 10J343 % Y)`
RET:).. 1'4;y PAULA JOY JOHNSCN.•:"\
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