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HomeMy WebLinkAboutSWG2020-00455 - SWG As-Built - 12/1/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH , APPLICANT/PERMIT INFORMATION Permit Number SWG 2020 00455 Parcel# 22212-11-90091 Applicant Name Hohmann,Leonard A&Kam L Subdivision (Name/Div/Block/Lot) Applicant Address 18311 State Route 106 City, State, Zip Belfair Wa 98528 Installer Name Shumaker Construction Site Address 18300 E State Route 106 Belfair Designer Name Paysse Pioneer Digging INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Gravity Pretreatment Type >5 ft.from foundation? - •- 0 N/A U YES ❑ NO >50 ft.from wells? - - 0 e 0 Z >50 ft.from surface water? - - El ® El H Cleanout between building and tank? - - El IN El 0 Tank baffles present? - - 0 ® 0 d24"access risers over each compartment?- - El III WW Effluent filter installed?- - 0 ® El Septic tank capacity(working) 1500 gal Manufacturer Hagermen's D-box water level and speed levelers used? - - 0 N/A MI YES ❑ NO XO0 Manifold/D-box accessible from surface?- - 0 IN El mZ Check valves installed? - - ® ❑ 0 0a 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 0 3 ©4 0 5 ❑6 ['Commercial/Other >10 ft.from foundation?- - 0 N/A ®YES ❑ NO CI >100 ft.from wells?- - ❑ ® ❑ W >100 ft.from surface water? - - El El Z >10 ft from potable water lines?- - ❑ ® 0 41 > 5 ft.from property lines and easements?- - 0 IN >30 ft.from downgradient curtain/foundation drains? 0 IN 0 Drainfield level and observation ports present - - 0 IN 0 0 Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 IN 0 Pump tank setbacks consistent with septic tank?- - 0 N/A 0 YES ❑ NO X Pump tank capacity(flood) gal Manufacturer 24"access riser(s)and accessible from surface?- - 0 0 0 aAlarm or Control Panel Installed? - - 0 ❑ 0 Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑ a- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 2 Pump Make/Model ❑ Floats or ❑ Transducer aTank 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 ■1■�Irir Mason County OSS Installation Report pg. 2 Parcel# 22212-11-90091 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES E 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 contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfiold,existing and proposed buildings,location of wets,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 l further certify that all information contained on this I further certify that all information contained on this form and attached eCbrdprawingIs accurate. form and attached Record Drawing is accurate. Signature of Installer Date A-Arnn ShumU ems✓ b+ Printed Name of Signee r,. MASON COUNTY PUBLIC HEALTH /• +;Z,•r The undersigned approves this Installation Report and ++" Record Drawing on behalf of Mason County Public .++•;•, !?eBE• R7.ii RA.s Health: 4, - . t.. _I,. ,,5 EXPIRES Ro \ Signature of Environmental Health Specialist Data (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated82f/2018 \ �. . . \ / \ / \ / / EXISTING WELL —\ r r I i / I i o / I I l`/— MOO' 1 / I DRAINFIELD \ / INSTALLED \\ / AS PER DESIGN \ \` A , O \ #N A „\: , �� \\\\���� \\\\� ���1``\\ /// ...,SEPTIC TANK (4) 0 3'x50'/ 10'OC 4� / W/ RESERVE BETWEEN // BUILDING SETBACK LINE: / 10' DF TO FOUNDATION C ,., 5'TANK TO FOUNDATION APPROX. BUILDING AREA ♦ \' '. ♦ \ ,. 4, , DECL% -.Fs„ MASON COUNTY ENVIRONMENTAL HEALTH 't(/ f f C4j 7 ♦ =1 OlD DRAINING PIONEER DICCINC, INC. CUSTOMER: KARRI HOHMANN SCALE 1:100 ' ' PARCEL#:M17-ll-90092 TEST HOLE I: TEST HOLE 2 SEPTIC DESIGNS ADDRESS: 18230 STATE ROUTE 106 C'.63 S o-72 CIS ROOTS-63 ROOTS-72 3083 E MASON BENSON RD. CRAPEVIEW,WA 98546 DESIGNER: ROBERT PAYSSE NO RA_ NO PA. OFFICE-360-426-1803 FAX-360-427-2353 DESIGN PAGE ASBUILT