HomeMy WebLinkAboutSWG2022-00020 - SWG As-Built - 4/27/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2o2-2-- D 6 OZ.o Parcel # 32026-76-90052
Applicant Name LISA GIRARD Subdivision (Name/Div/Block/Lot)
Applicant Address 2730 CEDAR ST
City, State, Zip EVERETT, WA 98201 Installer Name MAPLES EXCAVAI ING
Site Address 270 SE NURI E GLEN Designer Name CINDY WAITS
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type PRESSURE DIST Pretreatment Typo BNR 500 NUWATER
>5 ft.from foundation? - - ❑ N/A ® YES ❑ NO
>50 ft.from wells? - •- ❑ ® ❑
Z >50 ft.from surface water? - lt t V1 ❑ NE
H Cleanout between building and tank? - -- -- El UN
U tank baffles present? - APf. -21- ❑ NI
2t123-_.
a24" access risers over each compartment?-i►i- 0 II 0
W Effluent filter installed?. 4 - MEEl ❑
rn �By_
Septic tank size 1150 _gal _--Manufac _ HAGERMAN
9 D-box water level and speed levelers used? - - ® NIA ❑ YFS ❑ No
DO Manifold/D-box accessible from surface?- - ❑ a ❑
mZ Check valves installed? - - ❑ LW ❑
CIQ
2 Transport Line Size __ 2 Schedule/Class SCHEDULE 40
Bedrooms installed (check one) 0 2 E]3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- I - ❑ NIA ® YES ❑ NO
GII >100 ft.from wells? - i -• - ❑ ® ❑
W >100 ft. from surface water? - i - ❑ ® El
it: >10 ft.from potable water lines?- - ❑ ® ❑
Z > 5 ft. from property lines and easements?- - ❑ PI ❑
Ed.
> 30 ft. from downgradient curtain/foundation drains? - - Q ❑ ❑
ci
Drainfield level and observation ports present - - ❑ ❑ ❑
❑ Graveless chambers or f Clean gravel used? (check one)
Proper cover installed over drainfield?- -- - 0 ® ❑
Pump tank setbacks consistent with septic tank?- - - - - - ❑ N/A ® YES ❑ NO
Pump tank size 1200 _gal Manufacturer HAGERMAN
Q24" access riser(s)and accessible from surface?- - ❑ ® ❑
F-
a Alarm or Control Panel Installed? - - -- - ❑ PE ❑
2 Control Panel equipped with Timer;ETM/Counter- - ❑ ® ❑
m
a. Pump installed in ❑ Bucket or [ 'On Block or ❑ Other-_
Q Pump Maks/Model 2 r (/-et. ! 1ST- g Floats or ❑Transducer
a. Tank draw down 2 in/min Pump capacity 4;0 gpm Squirt Height 3 ft
Pump on time 2 •v% ! Pump off►ime 6 f S Daily flow set at 360 gpd
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Mason County OSS Installation Report pg. 2 Parcel # 32026-76-90052
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - - -- --- YES ED NO
If yes, please describe: _
Were all components pumped out and properly abandoned per WAC246-2f2A-0300? - - Q YES El NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re•iocate in the need of maintenance activities and future development Typral Record
Drawings contain' D a nneld&marrtold orientation&layout,Septic/pump(ant(location.North arrow,reserve dranrield,existing and proposed bud/linos.location of wells.waterlines.
walls.non/motion ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additonai delays In final installation approval and reialacl permits.
Serif
PPROVE •zi
APR2r2023
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
i certify that l installed the system in accoirdance 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 i further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record wing is accurate.
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Signature of Installer • Date ��e �P N
S tiw,n e ,�o,P1.e.5 �� .•
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Printed Name of Signee dofi = ti
MASON COUNTY PUBLIC HEALTH 100418 v \
The undersigned approves this Installation Report and o� D�E WRITE
r
LICENSED DESIGNER
IIP
Record Drawing on behalf of Mason County Public Amp.
EXPIRES 0500,
Health:
-
SigiLij
t f nvironmental Healt Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updowd Bat2018
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