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Home My WebLink AboutSWG2023-00397 - SWG As-Built - 7/31/2025 (2) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2023-00397 Parcel # 12205-21-90072 Applicant Name Alexander Lincoln Subdivision (Name/Div/Block/Lot) Applicant Address 267 NE Tahuya River Dr LOT B OF SP#2900 AF#673150 PTN OF NE NW City. State, Zip Tahuya WA 96588 Installer Name Shumaker Construction Site Address 460 NE Alder Creek Ln, Belfair Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Dramfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 f1 from foundation? - - - - - - - - - - - - - - - - - - -' ❑ NIA YES® ❑ NO >50 ft. from wells? - - - - - - - - - - ❑ ® ❑ Y >50 ft.from surface water? - - - - - ❑ ® ❑ z u ❑ FQ- Cleanout between building and tank? - 1�Mi- - - ❑ O Tank battlespresent? - - - - -- - - - ❑ ® ❑ a24" access risers over each companm nt?- Cl ® ❑ W Effluent fitter installed?- - - - - - - - - y- - ❑ ® ❑ N Hage man Septic tank capacity (working) 1,250 gal Manufacturer 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ❑ YES ® NO J OLL Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - - ❑ 9 mz Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ IN ❑ Transport Line Size 2" SchedulelClass 40 Bedrooms installed(check one) ❑ 2 ® 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - - - - - - - -p- - - - - - - ❑ NIA ® YES ❑ NO O >100 ft. from wells?- - -- -- - P�-[11K � Ja - - ❑ ® ❑ W >100 ft.from surface water? - - _ �R iE _ _ " ❑ e ❑ a >10 ft. from potable water lines - ❑ ® ❑ Z aU❑- - - - - - _ _ _ ❑ > 5 ft. from property lines and nts - ❑ > 30 ft-from downgradient curt art JN 'ILrLT'll CA. _ - ❑ ❑ 0 Drainfield level and observation ports preseniJ BIN- - - - - - - - - - C- - - - - - - - ❑ ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - - ' ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- - - - - - - -- - - — NIA YES ❑ NO Y Pump tank capacity(flood) 1 000 gal Manufacturer Hagerma n 2 p Q 24"access riser(s)and accessible from surface __ _ _ _ _ _ _ _ _ _ __ ❑ 111 ❑❑ H Alarm or Control Fanellnstalled? - - - - - - - - - - - - - - - - - - - - ' ❑ II IL'E Control Panel equipped with Timer I ETM I Counter-- - - - - - ❑ ® O - - - - 7 a Pump installed in ® Bucket or ❑ On Block or ❑ Other a Pump Make/Model Liberty 280 ® Floats or ❑ Transducer Tank draw down 2.25 in/min Pump capacity 43 gpm Squirt Height 6 ft Pump on time 2 min Pump off time 5hr Daily flow set at 360 qpd canes flama Mason County OSS Installation Report pg. 2 Parcel# 1220 S - 'L-1 - 4 0072 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --- fl YES NO If yes, please describe_ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? -" -- - "" ❑ 'E RECORD DRAWING mu s•p.m+.n.nl rKad.ne mWr W.ewnnnd. d..[nldrs mu+9a m r.-1.'e.1.in M. w.d S m.lnn+ww.gHkin ride nMn dnMaWnMit Typos ROry .w+ o+ we cm+u,n: o,wnSdxamw*pld onenmmal.ywd.sep�pw.np un.rouddn.Nom eno,..men dra✓sed..» +owwdp..d waeny,lx+edeaww.++mdn.e ls.CbeM4N+00M1s,d-Y+M1IY.Nd 0Ttt+NMiten.n2 dGR� tl. Inimale Read pfrMs m.Y aut..dM0W dray.in M wbinm.W1t vG ntl.Rd pumpstt APPROVED JUL 3 1 2025 — `1( , I'deEndo-:NMEr;TaiE_aT- JBW • Record DrawingAttached 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 actor- 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 clearedfapproved by both the designer shown here have been Geared/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 info ation contained on this I further certify that all information contained on this form and a a o I Drawing is accurate. form and attached Record Drawing is accurate. jo-4-2S S4Onattum of Installer Date A A Printed Name of Sgnee °r MASON COUNTY PUBLIC HEALTH .I The undersigned approves this installation Report and s1 o%O Record Drawing on behed of Mason County Public 1 PAULA JOY JOHNSON'. Health: i 7-( -z rat nmental Heat'Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNEDANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNtYWEB SITE °un+Y+e %ti $CALE0 Ibi.—t9 ' Li �' _ o e 4o uo 6e 5 i /- -^� I ALEX LINGoLN E / / P�iuEl.� l2zo5 2140012 D /IDy�� aoo NE Au9RCQEK IN T T I A Sf(A3 ?r Cry+�r w �fen.ocs �a.veWay — ' — y � ' �� with (ES�rv . QGC" G . t7 Rea 3 - Auo-Visual Alain -I" 'i diOA lPOS't / / Cleancut P Dr J 1200 Gallon Septic Tank 2 tn Comparenc with c�, Effluent Filter C� TG _ _ —J- i000 C-allan Pump Chant ST \ a — - O Valve Con tl Box ç !Yl 30' EASE•^EST 'v APPROVE salsa PAULA JOY JONtJapN •. JBW (4"Lr