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HomeMy WebLinkAboutSWG2022-00571 - SWG As-Built - 7/2/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2022-00571 Parcel# 22319-50-00062 Applicant Name Alex Ackley Subdivision (Name/Div/Block/Lot) Applicant Address 1903 Norma Rd NE Wooten Lake Tracts, TR 62 City, State, Zip Tacoma, WA 98422 Installer Name Shumaker Construction Site Address 2820 NE Tahuya Blacksmith Rd Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Subsurface Drip Pretreatment Type N Water BNR-500 >5ft. fromfoundation? - - - - - - - - - - - - - - - - - - - - - - - - - - `T ❑ A = YES NO >50ft - -. fromwells? - - - - - - - - -t- - - - - - - - - -- - ❑ c_ I ❑ Y >50 ft. from surface water? - ❑ Z C, Z Cleanoutbetweenbuildingandtank? - - - - - - - - - - - - - - - - - - ❑ � V Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - Ii ❑ a24" access risers over each compartment?- - - - - - - - - - - - - - -- rn ❑ WEffluent filter installed?- - - - - - - - - - - BN- - - - - - - - - - - - - ❑ UI Septic tank capacity (working) NuWater 500"gal Manufacturer n-coated t D-box water level and speed levelers used? - - - - -- - - - - -- - -- ❑ N/A ❑ YES ❑■ NO �O Manifold/D-box accessible from surface?- - ��=�`"-o- S - - - - - ❑ ❑■ ❑ 0DZ Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ UI ❑ oQ LE Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?- - - - --------- - -- - - - - - - - - ❑ N/A UI YES ❑ NO >100ft. fromwells?---�S-� _ - - - - - -- - - ❑ ❑ ❑■ >100ft. fromsurfacewater?- - - - - - - - -- - - - - - - - - - - -- - - ❑ ❑■ ❑ u. >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - -- - - ❑ M ❑ Z > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - O ❑■ ❑ Q £ > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ © ❑ n C�rayeleC ch-+mha,s or r—I Cie rava! used? (eheeI- .,t i Proper cover installed overdrainfield?- -- - - - - - -- - - - - - - - - - ❑ UI ❑ Pump tank setbacks consistent with septic tank?-- -- - - - - - - - -- ❑ N/A ❑■ YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman-coated H24" access riser(s) and accessible from surface?- - - - - - - - - -- - - ❑ ❑ a Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ UI ❑ Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - ❑ UI ❑ Pump installed in ❑ Bucket or ❑ On Block or ® Other flow inducer tube 0 Pump Make/Model Sta-Rite Step 20- 1/2hp, 115v, 20gpm Q Floats or ❑ Transducer Tank draw down 2"in 10 min in/min Pump capacity 3.8 gpm Squirt Height — ft Pump on time 5.3 min Pump off time 1.9 hr Daily flow set at 240 gpd Updated 8121/2018 Mason County OSS installation Report pg. 2 Parcel# 2 VSt -50-O 0 p(oZ- 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 contain: Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Seerac,�eo� "' E �z rj 22026 ENVIRONMENTAL NF, JW ■ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER If certify that I installed the system in accordance with /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 1 further certify that all information contained on this form and alt eeLRe Drawing is accurate. form and attached Record Drawing is accurate. Signature of Installer Date ��)) Punted Name of Signee rsczt< . MASON COUNTY PUBLIC HEALTH The undersigned approves this installation Report and t->� 100348 Record Drawing on behalf of Mason County Public PAULA JOY JOl It soN He h: Bit go -24 Sig atu e f 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 8O1/2018 i ! a 11 A ,� ri ft d n 'PJinJ ' S� � �'�lr Tw5 2 .2i ?� .`.✓r Spa �ar 9RtP � s 9. -- i:sy Key: O1 Audio-Visual Alarm L�e � C Cleanout ONuWater BNR-500 Pretreatment Tank ! [ 1,000 Gallon Pump Chamber it O Subsurface Drip System Headworks Yv S I — Tom' CJ�. �Je G.OGS+Ar r v - f .� 4 CiC- 4.e��� ;mac�LT'�.'� `.i`a V JJ /JV\ tea,, • JUL 02 r!_."''� 57UDJ 39 �'' NVIR ' '�} PAU!A JOY JOHNSON '� ^.4ASON COUNTY J'3� fa -2 -'�cp • . MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2022-00571 ADDRESS: 2820 NE Tahuya Blacksmith Rd PARCEL: 223195000062 DATE: 5/28/2026 P' C HOUSE TO DRAINFIELD �a r ! 1y 4; i .'�... DRAINFIELD TO HOUSE Kayla Milam From: DO NOT REPLY <noreply@masoncountywa.gov> Sent: Wednesday, May 27, 2026 7:41 AM To: Environrnentalhealth Subject: OSS Inspection request for Alex Ackley - 2022 00571 Submittal request for: Alex Ackley Site Address: 2820 NE Tahuya Blacksmith Rd Tahuya Permit Number: 2022 00571 Parcel Number: 22319-50-00062 Installer Name: Aaron Shumaker Installer Phone Number: 360 509 1222 1 ! r ''L MAY 17 2026 Installer Email Address: atshumaker@msn.com By Designer Name: paula Johnson Designer Email Address: paulaj@hctc.com Inspection Request Date: 2026-05-28 Inspection Type: Full System Comment\ Notes: Thank you for submitting your final install request.The install should be complete and ready to inspect on the 'Inspection Request Date' and remain uncovered for three business days to allow staff time to inspect. Poor weather situations may be accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backfill of system components. If no contact is made by the health department within the three business days of notice, the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 1