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HomeMy WebLinkAboutSWG2025-00290 - SWG As-Built - 3/1/2026 Mason C unty OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit 1 umber SWG 2025-00290 Parcel# 223064300010 Applica Name Mathew Hoch Subdivision (Name/Div/BlocklLot) Applica Address PO Box 366 City, Sta e,Zip Belfair Wa 98528 Installer Name Aaron Shumaker Site Add ess 6151 Ne Dewatto Holly Rd Designer Name , i L& INSTALLATION CHECKLIST ® F II System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type pressure Pretreatment Type >5 ft from foundation? --------- ❑N/A ®YES ❑ NO >50 .fromwellsc --________ _ ❑ >50 .from surface water? - ❑ ® ❑ ) FQ— Clea out between building and tank? -APR 202 __ ❑ ® ❑ Tan baffles present? --- ❑ ® ❑ 24"access risers over each compa r> t?--- - ❑ ® ❑ tW Effluant filter installed? ❑ ❑ Sep c tank capacity(working) 1250 gal Manua Hagermen's D-b water level and speed levelers used? --------------- ® N/A ❑YES ❑ NO 000 Man old/D-box accessible from surface?------------ ---- - ❑ ® ❑ GQChe kvalvesinstalled? ------------ ------------- - ❑ 0 X Iran port Line Size 2" Schedule/Class 40 Bed ooms installed (check one) ❑ 2 ❑3 4 ❑5 ❑6 ❑Commercial/Other >10t.from foundation?-____ _______________ ____ ❑ N/A ® YES ❑ NO >10 ft.from wells?-- -------- ------------------- ❑ ® ❑ W >10 ft.from surface water?-______ ____ ____________ ❑ ® ❑ M >10 I.from potable water lines?-_ ___________________- ❑ ® ❑ >5 .frompropertylinesandeasements?-- ------------- - ❑ ® ❑ W >30 t from downgradient curtain/foundation drains?-- - ----- -- ❑ ® ❑ Drai field level and observation ports present -- -- ---------- 0 ® ❑ ❑ raveless chambers or ® Clean gravel used? (check one) Prop r cover installed over drainfield?--------------- --- - ❑ ® ❑ Pum tank setbacks consistent with septic tank?----- ------- - ❑ N/A ® YES ❑ NO ZPum• tank capacity(flood) 1250 gal Manufacturer Hagermen's 24"a cess riser(s)and accessible from surface? ----------- - ® ❑ Alan or Control Panel Installed? Control Panel equipped with Timer/ETM/Counter -- -----__- ❑ ® ❑ Pum installed in ® Bucket or ❑ On Block or ❑ Other Pum Make/Model liberty 280 ®Floats or ❑ Transducer ._ O Tank raw down 2.25. in/min Pump capacity 50 gpm Squirt Height 6' ft Pum on time l Y .i So >c G. Pump off time Cl Lr Daily flow set aty0 gpd Updated 521,2018 ,1 I Mason C unty OSS Installation Report pg. 2 Parcel# 223064300010 ABANDONMENT RECORD Were exist' g septic components abandoned as part of this project? -------------- - ❑ YES © NO If yes,plea a describe: Were all co Iponents pumped out and properly abandoned per WAC246-272A-0300? ------- - ❑ YES NO II RECORD DRAWING This Is a perm8nent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings canter : Draintreld&manifold orientation&layout,Septic/pump tank location.North arrow,reserve drainfield.existing and proposed buildings,location of wells,waterlines. wells.observati pons,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 INSTAL ER DESIGNER/ENGINEER I certify t at I installed the system in accordance with I certify that the system has been installed in accor- the septi design stamped APPROVED"by Mason dance with the septic design stamped"APPROVED"by County ublic Health and that any deviations shown Mason County Public Health and that any deviations here hay been cleared/approved by both the designer shown here have been cleared/approved by both and Mas n County Public Health and meet all State myself and Mason County Public Health and meet all and Mas n County Codes. State and Mason County Codes I further ertify that all information contained on this I further certify that all information contained on this form an attached Record Drawing is accurate, form and attached Record Drawing is accurate. :::iii 7 ,Signature f Installer/ Date Printed N me of Signee MASON OUNTY PUBLIC HEALTH The and rsigned approves this Installation Report ' r.,' 1 RecordDrawing on behalf of Maspn County Public 's • Health: 16104, I • 4� Signature of Environmental Hea It Specialist Dc t /?D4r4. (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE 1BLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121/2018 AS-BUILT County Stamp 1375' APPROVED APR 11 2026 j � RflA�0N COUNTY ENVIRONiv1ENTAL E EALTH DJA Designer a p ��T •Av ��N D/W y 590' 4 "150' W 1l i bedroom 8 LICE S-00ES!G!ER '{} Home 1 - —`�- J Designer Info: 1 APDZ � C/O 7178 Windflo«'er PL NW «° \ Seabeck. WA 98380 \\ APDdesigns@icloud.com 75' 100'well radius % Applicant Info: Mathew Hoch $ 0 6151 Dewatto Holly Rd Seabeck Wa 98380 223064300010 Hydrosplitter Date: 3/ 1/2026 30' reserve 70' Scale NORTH 1" =50' NOT A SURVEY ti From: MATH athew.hoch@yahoo.com Subject: Reque, to take over as designer Date: April 1, 026 at 9:51 AM To: Jim Zim y apddesigns@icloud.com Hey Ji , I'm formally requesting that you take over the design from Brad Smith. Let me know if there is anything else you need. Thank you Sent fro Yahoo Mail for Phone