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HomeMy WebLinkAboutSWG2024-00170 ASBUILT - SWG As-Built - 3/15/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00170 Parcel# 123212490082 Applicant Name Rick LUKKASSON Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 2166 LOT 2 OF SP#3139 AF#216630 PTN OF SE NW City, State, Zip BELFAIR WA 98528 Installer Name Arron Shomakker Site Address 321 NE KATCHEMAK In,BELFAIR WA 98528 Designer Name Jim Zimny INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield ❑Repair ❑Other System Type \ J1\ \1 treatment Type >5 ft.from foundation? -- --- -- ------- --- ❑ N/A YES D O N >50ft. fromwells? --- ----- -- _ �� �_'�_ ._ __ ❑ ii ❑ >50ft. fromsurfacewater? ----- ---- -- -- - ----- ❑ © ❑ Z Cleanout between building and tank? -- ----- - ------ - ❑ ❑ CJ Tank baffles present? - -- - --- ---5Y_ _ .- - ❑ 0 ❑ 24"access risers over each compartment?-- -------------_ ❑ ® ❑ LU Effluent filter installed?- -------------------------- ❑ ®U) ❑ Septic tank capacity(working) 1250 gal Manufacturer Hagerman O D-box water level and speed levelers used? -- ------- ------ ❑ N/A 0 YES ❑ NO DO Manifold/D-box accessible from surface?----- ---- - ----- -- ❑ ® ❑ U Check valves installed? -- - - - ------ ------ ------- -_ ❑ ❑ S Transport Line Size 411 Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑! 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. fromfoundation?----------- --- --- --------- ❑ N/A nYES ❑ NO >100ft.fromwells?-- --------------------------- ❑ ❑ W >100ft.fromsurfacewater? ----- -- ----------------- ❑ ® ❑ >10ft.frompotablewaterlines?---------------------- ❑ ® ❑ >5 tt. from property lines and easements?---------------- ❑ ® ❑ >30 ft.from downgradient curtain/foundation drains?--------- - ❑ ® ❑ Drainfield level and observation ports present ----- --- ❑ ® ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ ® ❑ Pump tank setbacks consistent with septic tank?------ ------- © N/A ❑ YES ❑ NO zPump tank capacity(flood) gal Manufacturer g 24"access riser(s)and accessible from surface?------------- ❑ ❑ ❑ aAlarm or Control Panel Installed? ---------- -- ----- -- -- ❑ ❑ ❑ Control Panel equipped with Timer!ETM/Counter-- - --- ---- ❑ ❑ ❑ Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 2Pump Make/Mod I;, '` , ❑ Floats or ❑ Transducer Li- Ef g A' u L- p d Tank draw down in/min Pump a ity gpm Squirt Height ft MAY 28 20 Pump on time " ump` ff time Daily flow set at gpd MASON COUNTY E Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# l 2.3Z Z4(qa. Z ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -------------- - 0 YES 0 NO If yes,please describe: Were ail components pumped out and properly abandoned per WAC246-272A-0300? -------- ® YES NO r.: RECORD D WING This Is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance adivltlos and future development, rypcal Record Drawings contain:Draintleld&manifold orienial en&layout,SeptiNpump tank location,North srcw.reserve drain5etd,existing and proposed buildings.location of wells.waterluws, wets,obeervetion ports,cleanouls,and other maintenance access points. incomplete Record Dmw:ngs nmy orate additional delays in final Instaliauon approval and re!aled 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 a eT!•Rt3s rd Drawing is accurate, form and attached Record Drawing is accurate. Signature of stal/er Date Pri ed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and '1 Record Drawing on behalf of Mason County Public o° ' ',ry Hea m: LICENSED DES IONE R Sig to o E vrronmental Health Specialist Date (stamp,signature and date) THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updatrd grel.,701a County Stamp N w ASbuilt N ' 190' el 308' IRisered dbox 60' o ti --- ------------- -♦ esigner mp o - ----------- ----- 35' i Reserve TH#2I _____ - I ' LI DESIGNER ' i T Th#3 Designer Info: i -'-'-'- :4:be�lrooQn:Hon1e:• Jim Zunny APD N' ' '•'•'•'•'•'•' , 7178Windflo«'erPLNW I 00 Seabeck,WA 98380 68' bo : - APDdesigns@icloud.com Applicant Info: _ Ricky Lukkasson z 321 Katchemak Ln Belfair WA #123212490082 o \tea 40 Easement 46' Date: 3/1/26 i 3 e 3 8' Page o g m °`tea Z =3e Scale 1 30 Not A Survey